1 Department of Oral and Maxillofacial Surgery, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India

2 Department of Prosthodontics and Crown and Bridge, The KLE Academy of Higher Education and Research, KLE V.K. Institute of Dental Sciences and Hospital, Belgaum, Karnataka, India

3 Department of Oral Pathology and Microbiology, SJM Dental College and Hospital, Chitradurga, Karnataka, India

4 Department of Prosthodontics and Crown and Bridge, Nitte (Deemed to be university), AB, Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India

5 Department of Prosthodontics and Crown and Bridge, Jaipur Dental College, Jaipur, Rajasthan, India

6 Division of Periodontology, Department of Preventive Dental Sciences, College of Dentistry, University of Ha’il, Ha’il, Kingdom of Saudi Arabia

7 Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post‑Graduate Research Institute, Parbhani, Maharashtra, India


Osteoporosis is a specific condition which is characterized by low bone mineral density (BMD) and
deterioration of bone structure resulting in an increased susceptibility to fractures. It contributes to a
great deal of morbidity and mortality, and is a large burden to the healthcare system, especially in the
case of the elderly population. In the last four decades, a plethora of studies have reported characteristic
oral radiographic findings in the early stages of osteoporosis, suggesting the possible use of oral
radiographic signs for the early detection of the condition. Digital orthopantomographs (OPGs) are
usually taken for the screening of dental patients during routine dental evaluations. These radiographs
and the characteristic changes seen on them may have a significant role in the screening for initial
osteoporotic changes. A number of precise radiomorphometric indices of the mandible have also
been developed to allow quantification of the mandibular bone mass for identification of the initial
signs of osteoporosis. The present review focuses on the possible role of panoramic radiographs in
the initial screening for osteoporosis in dental clinics in high‑risk groups.


  1. Lane NE. Epidemiology, etiology and diagnosis of osteoporosis.
    Am J Obstet Gynecol 2006;194:S3‑11.
    2. Wilkins CH, Birge SJ. Prevention of osteoporotic fractures in the
    elderly. Am J Med 2005;118:1190‑5.
    3. Boonen S, Dejaeger E, Vanderschueren D, Venken K, Bogaerts A,
    Verschueren S, et al. Osteoporosis and osteoporotic fracture
    occurrence and prevention in the elderly: A geriatric perspective.
    Best Pract Res Clin Endocrinol Metab 2008;22:765‑85.
    4. Manring MM, Calhoun JH. Biographical sketch: Fuller Albright.
    Clin Orthop Relat Res 2011;469:2092‑5.
    5. EttingerMP. Aging bone and osteoporosis: Strategies for preventing
    fractures in the elderly. Arch Intern Med 2003;163:2237‑46.
    6. Martens MG. Risk of fracture and treatment to prevent
    osteoporosis‑related fracture in post‑menopausal women:
    A review. J Reprod Med 2003;48:425‑34.
    7. Vondracek SF, Hansen LB, McDermott MT. Osteoporosis risk in
    pre‑menopausal women. Pharmacotherap 2009;29:305‑17.
    8. Raisz LG. Pathogenesis of osteoporosis: Concepts, conflicts and
    prospects. J Clin Invest 2005;115:3318‑25.
    9. HamdyRC. Osteoporosis: An update. J Clin Densitom 2017;20:131.
    doi: 10.1016/j.jocd. 2017.04.001.
    10. Dargent‑Molina P, Douchin MN, Cormier C, Meunier PJ, Bréart G,
    EPIDOS Study Group. Use of clinical risk factors in elderly women
    with low bone mineral density to identify women at higher risk
    of hip fracture: The EPIDOS prospective study. Osteoporos Int
    11. Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone
    mineral density and fracture burden in post‑menopausal women.
    Can Med Assoc J 2007;177:575‑80.
  2. 12. Lewiecki EM. Prevention and treatment of post‑menopausal
    osteoporosis. Obstet Gynecol Clin North Am 2008;35:301‑15.
    13. Honig S. Low bone mass: Assessing absolute fracture risk and the
    need to treat younger post‑menopausal women. Bull NYU Hosp
    Jt Dis 2009;67:281‑4.
    14. Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV.
    Residual lifetime risk of fractures in women and men. J Bone
    Miner Res 2007;22:781‑8.
    15. Wilkins CH. Osteoporosis screening and risk management. Clin
    Interv Aging 2007;2:389‑94.
    16. Trémollieres FA, Pouillès JM, Drewniak N, Laparra J, Ribot CA,
    Dargent‑Molina P. Fracture risk prediction using BMD and clinical
    risk factors in early post‑menopausal women: Sensitivity of the
    WHO FRAX tool. J Bone Miner Res 2010;25:1002‑9.
    17. NIH Consensus Development Panel on Osteoporosis Prevention,
    Diagnosis, and Therapy. Osteoporosis prevention, diagnosis and
    therapy. J Am Med Assoc 2001;285:785‑95.
    18. Mauck KF, Clarke BL. Diagnosis, screening, prevention and
    treatment of osteoporosis. Mayo Clin Proc 2006;81:662‑72.
    19. Sweet MG, Sweet JM, Jeremiah MP, Galazka SS. Diagnosis and
    treatment of osteoporosis. Am Fam Physician 2009;79:193‑200.
    20. Golob AL, Laya MB. Osteoporosis: Screening, prevention and
    management. Med Clin North Am 2015;99:587‑606.
    21. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK,
    Barry MJ, Caughey AB, et al. Screening for osteoporosis to prevent
    fractures: US preventive services task force recommendation
    statement. J Am Med Assoc 2018;319:2521‑31.
    22. O’Connor KM. Evaluation and treatment of osteoporosis. Med
    Clin North Am 2016;100:807‑26.
    23. Jin J. Screening for osteoporosis to prevent fractures. J Am Med
    Assoc 2018;319:2566. doi: 10.1001/jama. 2018.8361.
    24. Cauley JA. Screening for osteoporosis. J Am Med Assoc
    25. SànchezRiera L, Wilson N, Kamalaraj N, Nolla JM, Kok C, Li Y,
    et al. Osteoporosis and fragility fractures. Best Pract Res Clin
    Rheumatol 2010;24:793‑810.
    26. Lewiecki EM. Clinical applications of bone density testing for
    osteoporosis. Minerva Med 2005;96:317‑30.
    27. McCloskey E. Preventing osteoporotic fractures in older people.
    Practitioner 2011;255:19‑22.
    28. Siris ES, Baim S, Nattiv A. Primary care use of FRAX: Absolute
    fracture risk assessment in post‑menopausal women and older
    men. Postgrad Med 2010;122:82‑90.
    29. Baró F, CanoA, Sánchez BorregoR, FerrerJ, González Rodríguez SP,
    Neyro JL, et al. Frequency of FRAX risk factors in osteopenic
    post‑menopausal women with and without history of fragility
    fracture. Menopause 2012;19:1193‑9.
    30. Viswanathan M, Reddy S, Berkman N, Cullen K, Middleton JC,
    Nicholson WK, et al. Screening to prevent osteoporotic fractures:
    Updated evidence report and systematic review for the US
    preventive services task force. J Am Med Assoc 2018;319:2532‑51.
    31. Formica CA, Nieves JW, Cosman F, Garrett P, Lindsay R.
    Comparative assessment of bone mineral measurements using
    dual X‑ray absorptiometry and peripheral quantitative computed
    tomography. Osteoporos Int 1998;8:460‑7.
    32. El‑Desouki MI, Sherafzal MS, Othman SA. Comparison of
    bone mineral density with dual energy x‑ray absorptiometry,
    quantitative ultrasound and single energy x‑ray absorptiometry.
    Saudi Med J 2005;26:1346‑50.
    33. Blake GM, Fogelman I. Dual energy x‑ray absorptiometry and its
    clinical applications. Semin Musculoskelet Radiol 2002;6:207‑18.
    34. Blake GM, Fogelman I. The role of DXA bone density scans in
    the diagnosis and treatment of osteoporosis. Postgrad Med J
    35. Blake GM, Fogelman I. Role of dual‑energy X‑ray absorptiometry
    in the diagnosis and treatment of osteoporosis. J Clin Densitom
    36. Blake GM, Fogelman I. The clinical role of dual energy X‑ray
    absorptiometry. Eur J Radiol 2009;71:406‑14.
    37. Blake GM, Fogelman I. An update on dual‑energy x‑ray
    absorptiometry. Semin Nucl Med 2010;40:62‑73.
    38. Tanner SB. Dual‑energy X‑ray absorptiometry in clinical
    practice: New guidelines and concerns. Curr Opin Rheumatol
    39. Lorente Ramos RM, Azpeitia Armán J, Arévalo Galeano N,
    Muñoz Hernández A, García Gómez JM, Gredilla Molinero J.
    Dual energy xray absorptimetry: Fundamentals, methodology
    and clinical applications. Radiologia 2012;54:410‑23.
    40. Lim LS, Hoeksema LJ, Sherin K, ACPM Prevention Practice
    Committee. Screening for osteoporosis in the adult U.S.
    population: ACPM position statement on preventive practice.
    Am J Prev Med 2009;36:366‑75.
    41. Dervis E. Oral implications of osteoporosis. Oral Surg Oral Med
    Oral Pathol Oral Radiol Endod 2005;100:349‑56.
    42. Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes AR.
    Mandibular morphological changes in low bone mass edentulous
    females: Evaluation of panoramic radiographs. Oral Surg Oral
    Med Oral Pathol Oral Radiol Endod 2006;102:663‑8.
    43. Lee K, Taguchi A, Ishii K, Suei Y, Fujita M, Nakamoto T, et al.
    Diagnostic efficacy of alveolar bone loss of the mandible for
    identifying post‑menopausal females with femoral osteoporosis.
    Dentomaxillofac Radiol 2007;36:28‑33.
    44. White SC. Oral radiographic predictors of osteoporosis.
    Dentomaxillofac Radiol 2002;31:84‑92.
    45. Taguchi A. Triage screening for osteoporosis in dental clinics
    using panoramic radiographs. Oral Dis 2010;16:316‑27.
    46. Božic M, Ihan Hren N. A novel method of dental panoramic
    tomogram analysis: A perspective tool for a screening test for
    osteoporosis. J Craniomaxillofac Surg 2013;41:808‑15.
    47. Marandi S, Bagherpour A, Imanimoghaddam M, Hatef M,
    Haghighi A. Panoramicbased mandibular indices and bone
    mineral density of femoral neck and lumbar vertebrae in women.
    J Dent (Tehran) 2010;7:98‑106.
    48. Leite AF, Figueiredo PT, Barra FR, Melo NS, de Paula AP.
    Relationships between mandibular cortical indexes, bone
    mineral density and osteoporotic fractures in Brazilian men
    over 60 years old. Oral Surg Oral Med Oral Pathol Oral Radiol
    Endod 2011;112:648‑56.
    49. Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone
    mass as measured by a panoramic mandibular index. Oral Surg
    Oral Med Oral Pathol 1991;71:349‑56.
    50. Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment
    of the osteoporosis risk group. Scand J Dent Res 1994;102:68‑72.
    51. Ledgerton D, Horner K, Devlin H, Worthington H.
    Radiomorphometric indices of the mandible in a British female
    population. Dentomaxillofac Radiol 1999;28:173‑81.
    52. Gulsahi A, Yüzügüllü B, Imirzalioglu P, Genç Y. Assessment of
    panoramic radiomorphometric indices in Turkish patients of
    different age groups, gender and dental status. Dentomaxillofac
    Radiol 2010;39:284‑9.
    53. Leite AF, Figueiredo PT, Guia CM, Melo NS, de Paula AP.
    Correlations between seven panoramic radiomorphometric
    indices and bone mineral density in post‑menopausal women. Oral
    Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:449‑56.
    54. Ghosh S, Vengal M, Pai KM, K Abhishek. Remodeling of the
    antegonial angle region in the human mandible: A panoramic
    radiographic cross‑sectional study. Med Oral Patol Oral Cir Bucal