The accuracy of panoramic radiographs as a screening of bone mineral density in women: a meta-analysis.
Dentomaxillofac Radiol. 2019 Oct 09;:20190149 Authors: Kinalski MA, Boscato N, Damian MF
OBJECTIVES: A systematic review (SR) and meta-analysis (MA) of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes (RIs) observed in panoramic radiographies (PR) could estimate reduced bone mineral density (BMD) similarly to standard technique the bone densitometry (DXA) in females older than 30 years. METHODS: A systematic search in four databases was conducted until January 2019. Two evaluators performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Data were synthesized on a subgroup MA with a random effect model and the hierarchical summary receiver-operating characteristic curve was used to calculate pooled estimates of studies. RESULTS: Thirty-three studies were included and 12 different RIs identified, including MCI. The final number of cases pooled for the analysis was 5,266 females.The Mandibular Cortical Index (MCI) for BMD loss (osteopenia) presented values of sensitivity 0.81 (95% CI, 0.78-0.84) and specificity 0.48 (95% CI, 0.45-0.50), while for osteoporosis sensitivity 0.35 (95% CI, 0.30-0.40) and specificity 0.88 (95% CI, 0.86-0.90). The Mandibular Cortical Width (MCW) presented values of sensitivity 0.58 (95% CI, 0.40-0.73), specificity 0.73 (95% CI, 0.60-0.83) for osteopenia, while for osteoporosis sensitivity 0.57 (95% CI, 0.36-0.76) and specificity 0.83 (95% CI, 0.68-0.92). Due to the high sensitivity, MCI presented a potential value as a screening tool for initial BMD loss (osteopenia), once tests presenting high sensitivity are described as rarely missing subjects with the disease. To the other hand, MCI to osteoporosis and MCW for both conditions are not recommended because presented specificity higher than sensitivity. CONCLUSION: The Mandibular Cortical Index (MCI) can be recommended as a feasible tool to screen initial BMD loss (osteopenia) in females above 30 years old using PR exams. PMID: 31596133 [PubMed - as supplied by publisher]