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Introduction: Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. Materials and methods: A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). Results: Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. Conclusions: Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a chronic, multifactorial skeletal disease that occurs especially in women following a decrease in estrogen levels and decrease in bone mineral density. The aim of this study was to evaluate the relationship between qualitative and quantitative indexes in panoramic radiographs and quantitative indexes in CBCT images with femoral and vertebral BMD in postmenopausal women. Methods: This comparative cross-sectional study was performed on postmenopausal women aging 40 to 80 years attending for obtaining either panoramic radiograph or mandibular CBCT scan. Dual energy X-ray absorptiometry (DEXA) was performed from the femur and lumbar vertebra. Quantitative parameters of mental index (MI), panoramic mandibular index (PMI), antegonial index (AI) as well as qualitative parameters of mandibular cortical index (MCI) and trabecular bone pattern (TP) were evaluated in panoramic radiographs. Quantitative parameters computed tomography mandibular index (CTMI), computed tomography index (inferior) [CTI(I)] and computed tomography index (superior) [CTI(S)] were analyzed in CBCT images. Kolmogorov-Smirnov tests and Pearson correlation coefficient were used (α = 0.05). Results: In individuals with panoramic radiography, statistically significant correlations were observed between MI with vertebral and femoral T-score, AI with vertebral and femoral T-score (except for the right AI with femoral T-score), and TP with vertebral and femoral T-score (p < 0.05). In the group with CBCT scans, the correlations between CTMI with vertebral and femoral T-score, CTI(I) with vertebral and femoral T-score, and CTI(S) with vertebral and femoral T-score were statistically significant (p < 0.05). Conclusions: in CBCT images, quantitative indexes of CTMI, CTI(I), and CTI(S), and in panoramic images, quantitative indexes of MI and AI and qualitative index of TP can be used to predict the possibility of osteoporosis in postmenopausal women. [ABSTRACT FROM AUTHOR]

Featured Application: Opportunistic CBCT scans may be used to assess bone mineral density and fracture risk, improving the ability to track disease progression and helping clinicians to provide better care as osteoporosis can be detected early. Dual-energy X-ray absorptiometry is used to determine bone density in several pathologies, namely osteoporosis and fracture risk in post-menopausal women. The aim of this study was to identify, appraise and synthesize all available evidence about the correlation between Dual Energy X-ray Absorptiometry (DEXA) and Cone Beam Computed Tomography (CBCT) techniques through a systematic review. A systematic literature search was conducted in the following databases: PubMed via MEDLINE, Cochrane Library, EMBASE and Web of Science Core Collection, along with several sources of grey literature. The Cochrane Risk of Bias Tools were used to perform the qualitative assessment of the selected studies. A total of 913 articles were initially scrutinized and 11 were included for qualitative analysis, of which 3 were included in a meta-analysis. Most of the included studies revealed a low risk of bias (7 out of 11). A strong correlation (min r = 0.46 max r = 0.62) between DEXA and CBCT values were found. Thus, opportunistic CBCT scans may be used to assess the bone mineral density and fracture risk, improving the ability to track disease progression and providing better care. [ABSTRACT FROM AUTHOR]

We evaluated the correlation that Vitamin D (Vit D), cholesterol levels, and T- and Z-scores of dual-energy X-ray absorptiometry (DXA) scans have with cone beam computed tomography values assessed in the anterior and posterior regions of maxillary and mandibular jaws. In total, 187 patients were recruited for this clinical study. Patients' ages ranged between 45 and 65 years. Patients with valid DXA results, serum Vit D and cholesterol levels, and no evidence of bone disorders in the maxilla or mandibular region were included in the study and grouped in the control (non-osteoporosis) and case (osteoporosis) groups. Patients with a history of medical or dental disease that might complicate the dental implant therapy, chronic alcohol users, and patients who took calcium or Vit D supplements were excluded. The outcome variables assessed in the investigation were Vit D, cholesterol, Z-values, and cone beam computed tomography values. Regarding the case group, a significant (p < 0.05) inverse relationship was observed between Vit D and cholesterol. Although insignificant (p > 0.05), a positive relationship was found between Vit D and the cone beam computed tomography values in all regions of the jaws, except the mandibular posterior region (p < 0.05). Pearson correlation analysis was carried out. Vit D and cholesterol showed a statistically insignificant (p > 0.05) negative association with the cone beam computed tomography values in all regions of the jaws. However, the Z-values were highly correlated with the cone beam computed tomography values in all regions of the jaws (r > 7, p < 0.05). Vit D, cholesterol levels, and Z-values in women and men from young adulthood to middle age (45–65) were related with the cone beam computed tomography values of the jaws. [ABSTRACT FROM AUTHOR]

This literature review was conducted to analyze the capability of cone-beam computed tomography (CBCT) to accurately identify low bone mass density in women. A systematic search of MEDLINE, Embase, Scopus, Google Scholar, the Cochrane Library, and Science Direct was performed to identify relevant articles, and the Cochrane risk of bias criterion was used to determine the methodological quality of the included studies. All ten included studies assessed primary research on the capacity of CBCT to accurately diagnose insufficient bone mineral density. All relevant data were extracted, and the results were summarized narratively. The results indicated that the CBCT has good sensitivity and specificity and high accuracy in predicting osteoporosis. Four of the included studies measured qualitative values, while the others concentrated on quantitative values and found lower values in osteoporosis patients compared to those of osteopenic and healthy patients. All the studies compared CBCT grayscale values with dual energy X-ray absorptiometry scores, which strengthened our confidence in the accuracy of CBCT's diagnostic capability. CBCT is considered a feasible predictive tool for detecting patients who are at risk of osteoporosis, although further research is needed to confirm the evidence and enhance its common use among health care professionals. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a disease which is characterized by a decrease in general bone mineral density (BMD), resulting in decreased bone strength and an increased risk of bone fractures. The effect of reduced BMD on the jawbones is still not fully understood. The purpose of the study was to evaluate the impact of BMD on the quality and quantity of the edentulous mandible. Methods: The present study included 127 edentulous postmenopausal women who underwent cone beam computed tomography (CBCT) examinations. BMD measurements of the lumbar spine and femoral necks were performed by dual-energy X-ray absorptiometry. In the cross-sectional CBCT images, three different areas of the mandible (lateral incisor, first premolar, and first molar) were selected. The complete mandibular, trabecular, and cortical bone volumes were measured. All measurements were performed on the total mandibular area, and the basal and alveolar parts of the mandible. Results: The volume of the cortical bone was reduced for females with reduced BMD in the lateral incisor and first premolar regions, both in the total mandibular area and in the basal part of the mandible. The trabecular bone volume statistically significantly increased when the BMD decreased in the complete mandibular area and the basal part of the mandible (linear regression). The total bone volume significantly decreased with a decrease in BMD in the basal part of the mandible. Conclusions: Reduced BMD has a negative effect on the quantity and quality of bone in the basal part of the edentulous mandible. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency is one of the most common nutritional deficiencies worldwide. The amount and quality of bone at the implant installation site have an impact on the implant's prognosis however, the effects of menopause on jaw bone remain unknown. Few studies have looked at the prevalence of vitamin D deficiency in India's general population, but none have looked at the link between vitamin D deficiency (osteoporosis) and postmenopausal women's jaw Bone Mineral Density (BMD). This is the first study of its sort in India to look at postmenopausal women's vitamin D levels and jaw BMD. Aim: To evaluate and correlate vitamin D levels and jaw BMD in pre and postmenopausal females undergoing implant therapy. Materials and Methods: This cross-sectional study will include 50 partially or completely premenopausal (n=25) and postmenopausal females (n=25) having edentulous anterior and posterior maxillary and mandibular jaws. Females will be tested to evaluate their vitamin D levels and jaw BMD with Cone Beam Computed Tomography (CBCT) and results will be recorded in Hounsfield Units (HU) using Planmeca romexis viewer software. Chi-square test and Students t-test will be used. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites(second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated. Materials and Methods: In total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests. Results: The mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively. Conclusion: FD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability. [ABSTRACT FROM AUTHOR]

We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI. [ABSTRACT FROM AUTHOR]

CT scan by use of a beam-filter placed between the x-ray source and the patient allows a single-scan low-dose dual-energy imaging with a minimal hardware modification to the existing CT systems. We have earlier demonstrated the feasibility of such imaging method with a multi-slit beam-filter reciprocating along the direction perpendicular to the CT rotation axis in a cone-beam CT system. However, such method would face mechanical challenges when the beam-filter is supposed to cooperate with a fast-rotating gantry in a diagnostic CT system. In this work, we propose a new scanning method and associated image reconstruction algorithm that can overcome these challenges. We propose to slide a beam-filter that has multi-slit structure with its slits being at a slanted angle with the CT gantry rotation axis during a scan. A streaky pattern would show up in the sinogram domain as a result. Using a notch filter in the Fourier domain of the sinogram, we removed the streaks and reconstructed an image by use of the filtered-backprojection algorithm. The remaining image artifacts were suppressed by applying ${l}_{{0}}$ norm based smoothing. Using this image as a prior, we have reconstructed low- and high-energy CT images in the iterative reconstruction framework. An image-based material decomposition then followed. We conducted a simulation study to test its feasibility using the XCAT phantom and also an experimental study using the Catphan phantom, a head phantom, an iodine-solution phantom, and a monkey in anesthesia, and showed its successful performance in image reconstruction and in material decomposition. [ABSTRACT FROM AUTHOR]

Osteoporosis is a common health problem that affects one-third of women over the age of 50 and it may not be detected until bone fractures occur. Osteoporosis is low bone mass and microarchitectural deterioration of bone tissue, which affects bone fragility and raises fracture risks. Early mandible bone osteoporosis detection could help reduce the risk of jaw fracture and dental implant failure. To solve this problem, a diagnostic algorithm for automatic detection of osteoporosis in Cone-Beam Computed Tomography (CBCT) images is presented and 120 mandible CBCT images of 50-85 year-old women have been utilized. These images are classified into two classes: normal and osteoporotic. Their classification is based on the T-score which derives from the Dual-Energy X-ray Absorptiometry (DEXA). The proposed algorithm consists of image processing, feature extraction, and Artificial Neural Network (ANN) classification. Images are segmented and edges are detected. Then, texture features are extracted from the segmented regions. Finally, a feed-forward back-propagation ANN classifier is employed. Seven parameters were involved in the experiment data preparation as input: coarseness, contrast, direction, number of edges, length of edges, mean length of edges, and the number of edge pixels. The results demonstrate the effectiveness of the proposed method. With the help of the proposed method, dentists will be able to predict osteoporosis accurately and efficiently without the need for further examination since CBCT has been widely accepted in dentistry and the dentist is the most common health care professional that elderly visit regularly. [ABSTRACT FROM AUTHOR]

Cone beam computed tomography (CBCT) allows for the dimensional evaluation of jaw anatomic structures and the measurement of jawbone mineral density (BMD), to evaluate the relationship between the measured CBCT grayscale (GS) values and (dual X-ray absorptiometry) DXA scores among osteoporotic and normal dental implant participants. In addition, it can help to establish the CBCT GS values in different jaw regions that might indicate or associate osteoporosis. Eighty-one (81) participants (59 females and 22 males) were recruited into this clinical inquiry. Participants' ages ranged between 36 and 75 years (mean age ± SD: 57.9 ± 9.3 years). The inclusion criteria included patients diagnosed with osteoporosis and were indicated for the dental implant-supported prosthesis.GS values were calculated for each participant using the CBCT radiograph and associated computer software. The average T values obtained from L1, L2, L3 and L4 were recorded and evaluated for one time only, and correlated with CBCT GS values at different jaw positions. Associations between age, gender, GS values, and T values were evaluated by Pearson correlation tests. The GS values at posterior maxilla were able to predict the presence of osteoporosis (P < 0.001, R square = 0.849). On the other hand, attempts to predict T value using GS at different jaw sites showed that GS values at posterior maxilla and anterior mandible were able to predict T value (P < 0.001, R square = 0.924). The CBCT GS values of BMD at different jaw bone regions are significantly related to the DXA T values in the presence of osteoporosis. [ABSTRACT FROM AUTHOR]

Objetive: The diagnosis of osteoporosis has been based on the measurement of bone mineral density, although this variable has a limited capacity in discriminating patients with or without fractures. The application of finite element analysis (FE) on computed tomography volumetric images has improved the classification of subjects by up to 90%, although the radiation dose, complexity, and cost do not favor their regular practice. Our objective is to apply FE analysis to threedimensional models with dual-energy x-ray absorptiometry (3D-DXA), to classify patients who present osteoporotic fracture of the proximal femur and those without fracture. Material and methods: A cohort of 111 patients with densitometric osteoporosis was selected: 62 with fracture and 49 without it. Subject-specific FE models for impact were used, such as static simulation of lateral fall. Impact simulations allow identifying the critical region in 95% of cases, and the mechanical response to maximum lateral force. An analysis was performed using a discriminative classifier (Support Vector Machine) by fracture type, tissue and gender, using DXA measurements and biomechanical parameters. Results: The results showed a classification sensitivity of 100%, and a false negative rate of 0% for cases of neck fracture for trabecular bone in women. The variable major main stress (MPS) is identified as the best parameter for the classification. Conclusion: The results suggest that using 3D-DXA models help in order to better discriminate patients with raised fracture risk. [ABSTRACT FROM AUTHOR]

In this paper, we defined the relative cross-sectional area of forearm cortical bone and investigated its correlation with hip bone mineral density values of total femur, femoral neck, femoral trochanter, femoral inter-trochanter and femoral ward's triangle, respectively. Based on the correlations, we established a linear transformation between the relative cross-sectional area of forearm cortical bone and each hip bone BMD. We obtained forearm images using CBCT and hip bone BMDs using dual-energy X-ray absorptiometry (DXA) for 28 subjects. We also investigated the optimal forearm region to provide the strongest correlation coefficient. We used the optimized forearm region to establish each linear transformation to estimate BMD values for total femur, femoral neck, femoral trochanter, femoral inter-trochanter and femoral ward's triangle from the relative cross-sectional area of forearm cortical bone, respectively. We observed the strong correlations with total femur (r=0.889), femoral neck (r=0.924), femoral trochanter (r=0.821), femoral inter-trochanter (r=0.867) and femoral ward's triangle (r=0.895), respectively. The strongest correlation was observed in the forearm mid-shaft regions. Our results suggest that the hip bone BMD values can be simply estimated from forearm CBCT images in a convenient sitting position without X-ray exposure on a hip including genital organs, and may be useful for screening osteoporosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate changes in jaw bones due to osteoporosis using cone beam computed tomography (CBCT) images. Subjects that had undergone CBCT for various oral conditions and demonstrating clinical findings of osteoporosis were invited to participate in the study. Dual X-ray absorptiometry (DXA) was performed on 90 patients aged over 30 years who underwent CBCT. The study groups were based on DXA results, and included 26 osteoporosis patients (mean age ± standard deviation; 58.52 ± 5.91), 33 osteopenia patients (52.67 ± 8.61) and 31 healthy controls (49.81 ± 10.47). CBCT images of jaw bones were evaluated using radiomorphometric indexes, CT values, histogram analysis (HA) and fractal dimension (FD) analysis. Right and left mandibular radiomorphometric indexes, CT values and HA measurements in osteoporosis patients were significantly lower than measurements in osteopenia patients and control subjects (P ≤ 0.05). Positive correlations were observed between measurements of spine bone mineral density (BMD) and right and left mandibular CT values (P ≤ 0.01) and HA (P ≤ 0.01) measurements. Left maxilla FD measurements in osteoporosis patients were significantly lower than in the control (P ≤ 0.05) and osteopenia (P ≤ 0.05) groups. Osteoporosis caused significant changes in radiomorphometric indexes, CT values, and HA and FD measurements in the jaw bones. (J Oral Sci 58, 185-194, 2016). [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the use of dental cone-beam computed tomography (CBCT) in the diagnosis of osteoporosis among menopausal and postmenopausal women by using only a CBCT viewer program. Materials and Methods: Thirty-eight menopausal and postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) examination for hip and lumbar vertebrae were scanned using CBCT (field of view: 13 cm× 15 cm; voxel size: 0.25 mm). Slices from the body of the mandible as well as the ramus were selected and some CBCT-derived variables, such as radiographic density (RD) as gray values, were calculated as gray values. Pearson's correlation, one-way analysis of variance (ANOVA), and accuracy (sensitivity and specificity) evaluation based on linear and logistic regression were performed to choose the variable that best correlated with the lumbar and femoral neck T-scores. Results: RD of the whole bone area of the mandible was the variable that best correlated with and predicted both the femoral neck and the lumbar vertebrae T-scores; further, Pearson's correlation coefficients were 0.5/0.6 (p value= 0.037/0.009). The sensitivity, specificity, and accuracy based on the logistic regression were 50%, 88.9%, and 78.4%, respectively, for the femoral neck, and 46.2%, 91.3%, and 75%, respectively, for the lumbar vertebrae. Conclusion: Lumbar vertebrae and femoral neck osteoporosis can be predicted with high accuracy from the RD value of the body of the mandible by using a CBCT viewer program. [ABSTRACT FROM AUTHOR]