Karayianni K, Horner K, Mitsea A, Berkas L, Mastoris M, Jacobs R, Lindh C, van der Stelt P F, Harrison E, Adams J E, Pavitt S, Devlin H
Dental School, University of Athens, Greece.
Bone. 2007 Jan;40(1):223-9. doi: 10.1016/j.bone.2006.07.025. Epub 2006 Sep 18.
Clinical questionnaires and dental radiographic findings have both been suggested as methods of identifying women at risk of having osteoporosis and who might benefit from bone densitometry. The aim of this study was to measure the diagnostic accuracy of a combination of mandibular cortical width (MCW) measured from dental panoramic radiographs (DPRs) and the osteoporosis index of risk (OSIRIS) in the diagnosis of osteoporosis. 653 women (age range 45-70 years, mean age 54.95 years) in four European centres underwent standardised dual X-ray energy absorptiometry (DXA) to provide reference data on osteoporosis status. Each subject was interviewed to derive OSIRIS scores and underwent DPR examination. MCW was measured directly by five observers. Receiver Operating Characteristic (ROC) curve analysis was used to calculate sensitivities and specificities of the clinical and radiographic tests for the diagnosis of osteoporosis. 512 (78.4%) of the study population were classified as having normal BMD and 141 (21.6%) as having osteoporosis. Using ROC analysis, OSIRIS gave a ROC curve area (A(z)) of 0.838, with a sensitivity of 70.9% and a specificity of 79.5% at a diagnostic threshold of <or=+1. MCW on DPRs gave Az values for the five observers ranging from 0.71 to 0.78, providing sensitivities between 41.0% and 59.6% and specificities of between 81.8% and 90.3% at a diagnostic threshold of a 3 mm MCW and sensitivities between 94.2% and 99.3% and specificities of between 9.8% and 23.7% at a diagnostic threshold of a 4.5 mm MCW. Inter-observer repeatability was less than 2.15 mm for 95% of subjects. Combining clinical and radiographic tests had the effect of improving specificity at the expense of a fall in sensitivity. Diagnostic thresholds for MCW and OSIRIS can be chosen to provide the sensitivity and specificity combination that best suits locally determined needs. However, the addition of OSIRIS as a stepwise 'follow-up' test to radiographic assessment of MCW should only be performed if the aim is to have a test for which the highest achievable specificity is desired.
临床问卷和牙科X光检查结果都被认为是识别有骨质疏松风险以及可能从骨密度测量中受益的女性的方法。本研究的目的是测量从牙科全景X光片（DPR）测量的下颌骨皮质宽度（MCW）和骨质疏松风险指数（OSIRIS）相结合在骨质疏松诊断中的诊断准确性。欧洲四个中心的653名女性（年龄范围45 - 70岁，平均年龄54.95岁）接受了标准化双能X线吸收法（DXA）以提供骨质疏松状况的参考数据。对每位受试者进行访谈以得出OSIRIS评分，并进行DPR检查。由五名观察者直接测量MCW。使用受试者操作特征（ROC）曲线分析来计算临床和影像学检查对骨质疏松诊断的敏感性和特异性。研究人群中有512名（78.4%）被分类为骨密度正常，141名（21.6%）患有骨质疏松。使用ROC分析，OSIRIS的ROC曲线面积（A(z)）为0.838，在诊断阈值≤ +1时，敏感性为70.9%，特异性为79.5%。DPR上的MCW，五名观察者的Az值在0.71至0.78之间，在诊断阈值为3 mm MCW时，敏感性在41.0%至59.6%之间，特异性在81.8%至90.3%之间；在诊断阈值为4.5 mm MCW时，敏感性在94.2%至99.3%之间，特异性在9.8%至23.7%之间。95%的受试者观察者间重复性小于2.15 mm。将临床和影像学检查相结合有提高特异性但以敏感性降低为代价的效果。可以选择MCW和OSIRIS的诊断阈值以提供最适合当地确定需求的敏感性和特异性组合。然而，仅当目标是进行具有最高可实现特异性的检测时，才应将OSIRIS作为对MCW影像学评估的逐步“后续”检测来进行。
