An underdiagnosed manifestation: Mandibular bone loss in primary hyperparathyroidism

Area of Science:

• Endocrinology
• Osteology
• Radiology

Background:

• Primary hyperparathyroidism (PHPT) is a metabolic disorder linked to decreased bone mineral density and osteoporosis.
• Oral manifestations, including mandibular bone loss, are common in PHPT but their systemic implications are not fully understood.

Purpose of the Study:

• To investigate mandibular bone loss in PHPT patients.
• To determine the association between mandibular bone loss and osteoporosis in PHPT patients.

Main Methods:

• A case-control study involving 111 PHPT patients and 115 controls.
• Panoramic radiographs assessed mandibular bone loss using the Parathyroid Mandibular Index (PMI) and Klemetti Index (KI).
• Dual-energy X-ray absorptiometry (DXA) evaluated bone mineral density and diagnosed osteoporosis.

Main Results:

• PHPT patients exhibited significantly greater mandibular bone loss (lower PMI, advanced KI) than controls.
• Within the PHPT group, osteoporosis was associated with poorer PMI and KI scores.
• PMI scores positively correlated with skeletal bone density (t-scores) and independently predicted osteoporosis.

Conclusions:

• Mandibular bone loss, especially reduced PMI, may serve as an early indicator of osteoporosis in PHPT.
• Panoramic radiography offers a potential tool for osteoporosis risk assessment in PHPT patients.
• This study highlights the link between mandibular bone health and systemic bone disease in PHPT.