Osteoporosis and jawbones: dental panoramic radiographs to screen for post-menopausal osteoporosis and correlation between periodontal status and bmd

Osteoporosis is the most common chronic bone disease that may interfere with bone metabolism. This PhD thesis aimed to investigate the effect of osteoporosis on the jawbones, in particular the relationship between the systemic bone density and the jawbone conditions. Firstly, a literature review on the effect of osteoporosis on the jawbones and on the accuracy of panoramic morphometric indices to screen for reduced bone mineral density were presented. Despite the poor quality of the available studies, our data showed that a correlation between jawbone and skeletal density in osteoporotic patients might be expected. A second critical review on the correlation between osteoporosis and periodontal condition of the patients were done. Similarly to the aforementioned review, despite the quality of the papers, a correlation has been suggested. Secondly, a clinical trial to compare BMD and jawbones condition in terms of bone density and periodontal status were presented. Seventy patients, that were done a Dxa scan to investigate the BMD in the previous year, were enrolled and a complete periodontal data collection as well as a standardized ortopantomography were done. T-scores from the Dxa scan were used to classify patients in healthy or osteoporotic and specific morphometric indices were measured on the OPG. Finally, a statistical analysis was performed and a significant correlation was found between BMD and a combination of two indices: the qualitative “Klemetti index” and the quantitative “mandibular cortical width”. The accuracy of these indices was calculated and the combination showed a high predictive value in detecting healthy patients. The statistical analysis applied to the periodontal indices showed that pocket probing depth  5 mm and attachment level 3-4 mm were correlated to healthy condition. These controversial results may be related to the limitations of the study that include the reduced sample size and the recruitment centre.