Fractal Dimension Analysis and Radiomorphometric Indices as Predictors for Low Bone Mineral Density in Postmenopausal Women: A CBCT-Based Study.

OBJECTIVES

This study assessed mandibular cone-beam computed tomography (CBCT) radiomorphometric indices and box-counting fractal dimension (FD) for the detection of osteoporosis in postmenopausal women. It also compared these parameters with those of a healthy control group and evaluated their correlation with bone mineral density measured using dual-energy X-ray absorptiometry (DXA).

METHODS

The study included 50 postmenopausal women aged > 45 years, who were categorized into osteoporotic and control groups based on DXA results. Mandibular CBCT radiomorphometric indices and FD analysis were performed.

RESULTS

Significant differences were observed in the CT cortical index, with Type 3 changes more frequently in the osteoporotic group (48.0%), whereas Type 1 morphology was predominant in controls (64.0%) (P < 0.001). Mean values were significantly lower in osteoporotic participants (0.24 ± 0.05, 0.29 ± 0.06, and 3.37 ± 0.53, respectively) compared with controls (0.29 ± 0.06, 0.35 ± 0.07, and 4.05 ± 0.46, respectively) (P ≤ 0.002). Fractal dimension value was significantly higher in the osteoporotic group (1.98 ± 0.01 vs. 1.96 ± 0.01, P < 0.001). Receiver operating characteristic analysis showed that an FD cutoff value of > 1.976 yielded 72.0% sensitivity and 100.0% specificity for distinguishing individuals with osteoporosis.

CONCLUSIONS

CBCT radiomorphometric indices may serve as a useful adjunct for identifying individuals at risk of osteoporosis and for guiding referral for further evaluation.