Postmenopozal Osteoporoz Hastalarında Bifosfonatların Mandibular Radyomorfometrik İndekslere Etkisi

Yıl 2023, Cilt: 24 Sayı: 3, 72 - 78, 31.12.2023

Sinan Ateş , Belgin Gülsün

Öz

Amaç: Osteoporoz, kemik kütlesinde azalma, mikro yapısında bozulma ve artmış kemik kırılganlığı riskiyle karekterize, kemiğin yapısal bir yetmezliğidir. Bifosfonatlar, kemik metabolizma bozukluklarında sıklıkla kullanılan kemik rezorbsiyonunun güçlü inhibitörleridir. Bu çalışmada postmenopozal osteoporoz tanısı konmuş, bifosfonat tedavisi alan ve almayan hastaların, mandibular radyomorfometrik indekslerinin kullanımıyla bifosfonatların mandibuladaki etkilerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza daha önce postmenopozal osteoporoz tanısı konmuş 45-70 yaş aralığında 60 kadın hasta dahil edildi. Hastalardan iki grup oluşturuldu. Birinci grupta bifosfonat kullanan 30 hasta, ikinci grupta ise bifosfonat kullanmayan (kontrol grubu) 30 hasta yer aldı. Hastalardan dijital panoramik radyografi alınarak, mandibular radyomorfometrik indekslerden mental indeks ve mandibular kortikal indeks bu radyografiler üzerinde ölçüldü. Hastaların omurga kemik mineral yoğunluklarını hesaplamak için bütün vücut DEXA kayıtları alındı.
Bulgular: Bifosfonat kullanan hastalarda, kullanmayan hastalara göre omurga kemik mineral yoğunluğunda istatistiksel olarak anlamlı fark bulundu (p=0,043). Bifosfonat kullanan hastalarla kullanmayan hastalar arasında mental indekste ve mandibular kortikal indekste ise istatistiksel olarak anlamlı bir fark saptanmadı. Mental indeksin osteoporoz riskini belirleme oranı %76,7 iken mandibular kortikal indeksin osteoporoz riskini belirleme oranı ise 91,7 olarak hesaplandı.
Sonuç: Diş hekimleri, panoramik radyografilerde mental indeksi ve mandibular kortikal indeksi kullanarak osteoporozun erken tanısında rol oynayabilirler.

Anahtar Kelimeler

Bifosfonat, dexa, radyomorfometrik indeks, postmenopozal osteoporoz

Effect of Bisphosphonates on Mandibular Radiomorphometric Indices in Postmenopausal Osteoporosis Patients

Öz

Aim: Osteoporosis is a structural failure of bone characterized by a decrease in bone mass, deterioration in its microstructure, and an increased risk of bone fragility. Bisphosphonates are potent inhibitors of bone resorption that are frequently used in disorders of bone metabolism.This study aimed to examine the effects of bisphosphonates on the mandible, using mandibular radiomorphometric indexes, in patients diagnosed with postmenopausal osteoporosis who received or did not receive bisphosphonate treatment.
Material and Method: 60 female patients between the ages of 45-70 who were previously diagnosed with postmenopausal osteoporosis were included in our study. Two groups of patients were created. There were 30 patients using bisphosphonates in the first group and 30 patients not using bisphosphonates (control group) in the second group. Digital panoramic radiographs were taken from the patients, and mental index and mandibular cortical index, which are mandibular radiomorphometric indices, were measured on these radiographs. Whole body DEXA records were taken to calculate the patients’ spine bone mineral density.
Results: A statistically significant difference was found in spine bone mineral density in patients using bisphosphonates compared to patients who did not use bisphosphonates (p=0.043). No statistically significant difference was detected in mental index and mandibular cortical index between patients using bisphosphonates and patients not using bisphosphonates. While the rate of determining the risk of osteoporosis of the mental index was 76.7%, the risk of osteoporosis of the mandibular cortical index was calculated as 91.7.
Conclusion: Dentists can play a role in early diagnosis of osteoporosis by using the mental and mandibular cortical indexes in panoramic radiographs.

Anahtar Kelimeler

Biphosphonate, dexa, radiomorphometric indices, postmenoposal osteoporosis

Etik Beyan

2017/3 protokol numarasıyla Dicle Üniversitesi, Diş Hekimliği Fakültesi Yerel Etik Kurulu

Kaynakça

• Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007;29(8):1548-1558. doi:10.1016/j.clinthera.2007.08.008
• NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785-795. doi:10.1001/jama.285.6.785
• Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006;38(2 Suppl 1):S4-S9. doi:10.1016/j.bone.2005.11.024
• Delaney MF. Strategies for the prevention and treatment of osteoporosis during early postmenopause. Am J Obstet Gynecol. 2006;194(2 Suppl):S12-S23. doi:10.1016/j.ajog.2005.08.049
• National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. 1999. Available at: http://www.nof.org/professionals/clinical. Accessed May 15, 2007.
• Nakamoto T, Taguchi A, Ohtsuka M, et al. Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners’ diagnostic performance. Osteoporos Int. 2003;14(8):659-664. doi:10.1007/s00198-003-1419-y
• Morita I, Nakagaki H, Taguchi A, et al. Relationships between mandibular cortical bone measures and biochemical markers of bone turnover in elderly Japanese men and women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):777-783. doi:10.1016/j.tripleo.2009.03.043
• Yasar F, Sener S, Yesilova E, Akgünlü F. Mandibular cortical index evaluation in masked and unmasked panoramic radiographs. Dentomaxillofac Radiol. 2009;38(2):86-91. doi:10.1259/dmfr/56808511
• White SC, Taguchi A, Kao D, et al. Clinical and panoramic predictors of femur bone mineral density. Osteoporos Int. 2005;16(3):339-346. doi:10.1007/s00198-004-1692-4
• Akshita D, Asha V. Reliability of panoramic radiographic indices in identifying osteoporosis among postmenopausal women. J Oral Maxillofacial Radiol. 2017;5(2):35.
• ​Journal of Oral and Maxillofacial Radiology 5th Volume 2nd issue: Available at: https://journals.lww.com/JOMR/toc/2017/05020
• Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res. 1994;102(1):68-72. doi:10.1111/j.1600-0722.1994.tb01156.x
• Ledgerton D, Horner K, Devlin H, Worthington H. Radiomorphometric indices of the mandible in a British female population. Dentomaxillofac Radiol. 1999;28(3):173-181. doi:10.1038/sj/dmfr/4600435
• Halling A, Persson GR, Berglund J, Johansson O, Renvert S. Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly. Osteoporos Int. 2005;16(8):999-1003. doi:10.1007/s00198-004-1796-x
• Horner K, Devlin H. The relationship between mandibular bone mineral density and panoramic radiographic measurements. J Dent. 1998;26(4):337-343. doi:10.1016/s0300-5712(97)00020-1
• Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767. doi:10.1016/S0140-6736 (02)08657-9
• McClung MR. Bisphosphonates in osteoporosis: recent clinical experience. expert opin pharmacother. 2000;1(2):225-238. doi:10.1517/ 14656566.1.2.225
• Waghray S, Velpula N, Dara BGB, Duddu MK, Narayen V, Allam NSJ. Mandibulo-osseous predictors of osteoporosis: A double-blind study on the correlation and comparison of mental index with bone mineral density in post-menopausal women. J Indian Acad Oral Med Radiol 2015;27(2):183. doi:10.4103/0972-1363.170134
• Taguchi A, Tsuda M, Ohtsuka M, et al. Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis. Osteoporos Int. 2006;17(3):387-394. doi:10.1007/s00198-005-2029-7
• Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int. 2002;13(5):373-378. doi:10.1007/s001980200042
• Gaur B, Chaudhary A, Wanjari PV, Sunil M, Basavaraj P. Evaluation of panoramic Radiographs as a Screening Tool of Osteoporosis in Post Menopausal Women: A Cross Sectional Study. J Clin Diagn Res. 2013;7(9):2051-2055. doi:10.7860/JCDR/2013/5853.3403
• Valerio CS, Trindade AM, Mazzieiro ET, Amaral TP, Manzi FR. Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women. Dentomaxillofac Radiol. 2013;42(10):20120059. doi:10.1259/dmfr.20120059
• Bajoria AA, Ml A, Kamath G, Babshet M, Patil P, Sukhija P. Evaluation of Radiomorphometric Indices in Panoramic Radiograph - A Screening Tool. Open Dent J. 2015;9:303-310. Published 2015 Jul 31. doi:10.2174/1874210601509010303
• Bollen AM, Taguchi A, Hujoel PP, Hollender LG. Case-control study on self-reported osteoporotic fractures and mandibular cortical bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(4):518-524. doi:10.1067/moe.2000.107802
• Alapati S, Reddy RS, Tatapudi R, Kotha R, Bodu NK, Chennoju S. Identifying risk groups for osteoporosis by digital panoramic radiography. Contemp Clin Dent. 2015;6(Suppl 1):S253-S257. doi:10.4103/0976-237X.166833
• Bhatnagar S, Krishnamurthy V, Pagare SS. Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density. J Clin Imaging Sci. 2013;3:23. Published 2013 Jun 6. doi:10.4103/2156-7514.113140
• Akshita D, Asha V. Reliability of panoramic radiographic indices in identifying osteoporosis among postmenopausal women. J Oral Maxillofacial Radiol 2017;5(2):35.
• Horner K, Devlin H. The relationships between two indices of mandibular bone quality and bone mineral density measured by dual energy X-ray absorptiometry. Dentomaxillofac Radiol. 1998;27(1):17-21. doi:10.1038/sj.dmfr.4600307
• Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int. 2002;13(5):373-378. doi:10.1007/s001980200042