Horner Keith, Allen Philip, Graham Jim, Jacobs Reinhilde, Boonen Steven, Pavitt Susan, Nackaerts Olivia, Marjanovic Elizabeth, Adams Judith E, Karayianni Kety, Lindh Christina, van der Stelt Paul, Devlin Hugh
School of Dentistry, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Aug;110(2):243-9. doi: 10.1016/j.tripleo.2010.03.035.
The OSTEODENT index is a predicted probability of osteoporosis derived from a combination of an automated analysis of a dental panoramic radiograph and clinical information. This index has been proposed as a suitable case-finding tool for identification of subjects with osteoporosis in primary dental care; however, no data exist on the relationship between OSTEODENT index and fracture risk. The aims of this study were to assess the relationship between the OSTEODENT index and hip fracture risk as determined by FRAX and to compare the performance of the OSTEODENT index and FRAX (without femoral BMD data), in determining the need for intervention as recommended in UK national treatment guidance.
The study was a retrospective analysis of data from 339 female subjects (mean age 55.3 years), from 2 centers: Manchester (UK) and Leuven (Belgium). Clinical information and femoral neck BMD were available for FRAX, and dental panoramic radiographic data and clinical information were available to calculate the OSTEODENT index. Subjects were classified into "treat" or "lifestyle advice and reassurance" categories using the National Osteoporosis Guideline Group (NOGG) threshold.
The OSTEODENT index result was significantly related to the 10-year probability of hip fracture derived from the reference standard FRAX tool (Rs = 0.67, P < .0001); 84 patients (24.8%) were allocated to the "treat" category on the basis of FRAX and the UK national guidance. Using this "treatment/no treatment" classification as the reference standard, ROC analysis showed no significant difference between areas under the curves for the OSTEODENT index (0.815) and the 10-year probability of hip fracture derived from the FRAX index without BMD (0.825) when used as tests for determining therapeutic intervention.
The results suggest that the OSTEODENT index has value in prediction of hip fracture risk. Prospective trials are needed to confirm this finding and to examine the feasibility for its use in primary dental care.
OSTEODENT指数是一种通过对牙科全景X线片进行自动分析并结合临床信息得出的骨质疏松症预测概率。该指数已被提议作为在初级牙科保健中识别骨质疏松症患者的合适筛查工具；然而，关于OSTEODENT指数与骨折风险之间的关系尚无数据。本研究的目的是评估OSTEODENT指数与FRAX确定的髋部骨折风险之间的关系，并比较OSTEODENT指数和FRAX（无股骨骨密度数据）在确定英国国家治疗指南中推荐的干预需求方面的表现。
本研究是对来自英国曼彻斯特和比利时鲁汶两个中心的339名女性受试者（平均年龄55.3岁）的数据进行的回顾性分析。FRAX可获取临床信息和股骨颈骨密度，而计算OSTEODENT指数则需要牙科全景X线片数据和临床信息。根据国家骨质疏松症指南小组（NOGG）的阈值，将受试者分为“治疗”或“生活方式建议及安慰”两类。
OSTEODENT指数结果与参考标准FRAX工具得出的10年髋部骨折概率显著相关（Rs = 0.67，P <.0001）；根据FRAX和英国国家指南，84名患者（24.8%）被归为“治疗”类别。以这种“治疗/不治疗”分类作为参考标准，ROC分析显示，当用作确定治疗干预的测试时，OSTEODENT指数（0.815）和无骨密度的FRAX指数得出的10年髋部骨折概率（0.825）的曲线下面积之间无显著差异。
结果表明，OSTEODENT指数在预测髋部骨折风险方面具有价值。需要进行前瞻性试验来证实这一发现，并检验其在初级牙科保健中使用的可行性。
