Relationship between bone alterations detected in panoramic radiographs and osteoporosis


  • Bruna Akinaga Moreira Universidade de São Paulo
  • Eduardo Massaharu Aoki Universidade de São Paulo
  • Luciana Munhoz Universidade de São Paulo
  • Emiko Saito Arita Universidade de São Paulo



Osteoporosis, Panoramic radiograph, Styloid process, Bone mineral density


Objectives: Since the screening for low systemic bone mineral density (BMD) can be performed using panoramic radiography (PR), the use of other detectable signs in PR that could increase the rate of patients correctly indicated for dual bone densitometry (DXA) is still needed. Hence, this study aims to correlate low BMD with Body Mass Index (BMI) and visible changes on PR: elongated styloid process, mandibular cortical index (MCI), and number of teeth. Material and methods: PRs of 23 patients who had a DXA exam were used. Each patient was classified by three examiners with different levels of expertise (beginner, experienced, and expert) according to the MCI; the styloid process, as normal or elongated; the number of teeth; and the BMI. Results: A significant correlation was observed between the MCI and the DXA only for the expert observer (r=−0.47). For the other variables (elongated styloid process, number of teeth, and BMI) no significant correlations were observed. The inter-examiner agreement was 0.50 for the expert observer and the beginner, 0.27 for the experienced and the expert, and 0.58 for the experienced and beginner. The intra-examiner correlation was 0.77 for the expert, 0.48 for the beginner, and 0.28 for the experienced observer. Conclusion: The MCI showed a significant correlation with low bone mineral density; however, no evidence was found of a relationship between low bone mineral density and other detectable signs in RP.


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Author Biographies

Bruna Akinaga Moreira, Universidade de São Paulo

Faculdade de Odontologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil.

Eduardo Massaharu Aoki, Universidade de São Paulo

Faculdade de Odontologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil

Luciana Munhoz, Universidade de São Paulo

Faculdade de Odontologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil.

Emiko Saito Arita, Universidade de São Paulo

Faculdade de Odontologia, Universidade de São Paulo (USP), São Paulo, SP, Brasil.


World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO Study Group. Geneva: WHO; 1994.

White SC, Atchison KA, Gornbein JA, Nattiv A, Paganini-Hill A, Service SK, et al. Change in mandibular trabecular pattern and hip fracture rate in elderly women. Dentomaxillofac Radiol. 2005;34(3):168-74. Doi:

Taguchi A, Tsuda M, Ohtsuka M, et al. Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis. Osteoporosis Int. 2006;17(3):387-94. Doi:

Taguchi A, Tsuda M, Ohtsuka M, Tanimoto K. [Screening for osteoporosis by dental panoramic radiographs]. Clin Calcium. 2006;16(2):291-7

Nagi R, Devi B K Y, Rakesh N, Reddy SS, Santana N, Shetty N. Relationship between femur bone mineral density, body mass index and dental panoramic mandibular cortical width in diagnosis of elderly postmenopausal women with osteoporosis. J Clin Diagn Res. 2014;8(8):ZC36-40. Doi:

Calciolari E, Donos N, Park JC, Petrie A, Mardas N. Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis. J Dent Res. 2015;94(Suppl 3):17S-27S. Doi:

Frazão P, Naveira M. Prevalência da osteoporose: uma revisão crítica. Rev Bras Epidemiol. 2006;9(2):2006. Doi:

Russell RG, Espina B, Hulley P. Bone biology and the pathogenesis of osteoporosis. Curr Opin Rheumatol. 2006;18(Suppl 1):S3-10. Doi:

Gokce C, Sisman Y, Sipahioglu M. Styloid Process Elongation or Eagle's Syndrome: Is There Any Role for Ectopic Calcification? Eur J Dent. 2008;2(3):224-8

Kim YM, Kim SH, Kim S, Yoo JS, Choe EY, Won YJ. Variations in fat mass contribution to bone mineral density by gender, age, and body mass index: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011. Osteoporos Int. 2016;27(8):2543-54. Doi:

Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res. 1994;102(1):68-72. Doi:

Munhoz L, Abdala R Jr, Choi IGG, Arita ES. Diffusion-weighted magnetic resonance imaging of mandibular bone marrow: do apparent diffusion coefficient values of the cervical vertebrae and mandible correlate with age? Oral Radiol. 2022;38(1):72-9. Doi:

Munhoz L, Aoki EM, Cortes ARG, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology. 2018;35(2):101-9. Doi:

Watanabe PC, Dias FC, Issa JP, Monteiro SA, de Paula FJ, Tiossi R. Elongated styloid process and atheroma in panoramic radiography and its relationship with systemic osteoporosis and osteopenia. Osteoporos Int. 2010;21(5):831-6. Doi:

Taguchi A, Asano A, Ohtsuka M, Nakamoto T, Suei Y, Tsuda M, et al. Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD). Bone. 2008;43(1):209-13. Doi:

Munhoz L, Kim JH, Park M, Aoki EM, Reinaldo Abdala Júnior R , Arita ES. Performance evaluation of different observersin the interpretation of panoramic radiographs by the mandibular cortical index. Rev Odonto Ciência. 2018;33(1):5-9. Doi:

Yasar F, Akgunlu F. Evaluating mandibular cortical index quantitatively. Eur J Dent. 2008;2(4):283-90.





Original Research