Anteroposterior versus lateral bone mineral density of spine assessed by dual X-ray absorptiometry

Recently, it has been suggested that lateral (LAT) spine bone mass measurements by absorptiometry may be more sensitive for detecting bone loss than the standard anteroposterior (AP) projection. The aim of this study was to evaluate the precision of LAT spine dual-energy X-ray absorptiometry (DEXA) and its diagnostic sensitivity. A group of 1554 subjects with no risk factors that might affect bone metabolism and 185 osteoporotic patients with vertebral fractures were studied. Bone mineral density (BMD) was measured in the lumbar spine (standard AP and LAT projections) and proximal femur with a DEXA absorptiometer. The precision of the measurements was assessed in 15 volunteers. Diagnostic sensitivity was evaluated by the Z-score method. Comparing young people and the elderly, spine bone loss in the latter was similar for AP and LAT projections, when it was evaluated in absolute values (glcm²). However, when it was evaluated in percentage terms, bone loss was about twice as high in the LAT projection. LAT spine BMD correlated significantly with all the other areas assessed. The best correlation was found with the standard AP projection (r=0.67,P<0.0001). The precision in the LAT projection was found to be within an acceptable range (1.6% in normal subjects, 2% in osteoporotic patients), even though it was about twice that obtained in the AP projection. Diagnostic sensitivity was also better with the AP projection. It is concluded that LAT spine BMD measurements can be assessed with acceptable precision although it is about twice as high as for AP spine measurements. The percentage decrease in BMD in the elderly is greater for measurements made in the LAT projection than for measurements made in the AP projection. However, there is no enhancement of diagnostic sensitivity in osteoporosis. BMD measurements in the LAT projection are not as good as in the AP projection but they may offer complementary information of the regional evolution of spine bone mass.     

DXA椎体骨折评估联合腰椎侧位骨密度诊断老年性骨质疏松的临床研究

目的研究双能X线吸收检测法（DXA）椎体骨折评估（VFA）联合腰椎侧位骨密度诊断老年性骨质疏松的效能。方法选取我院DXA同时检测髋部、腰椎前后位、腰椎侧位骨密度及VFA的老年受检者86例,根据DXA骨密度低下或VFA有脆性骨折诊断骨质疏松。比较腰椎侧位骨密度联合VFA与常规DXA检测髋部及腰椎前后位骨密度诊断骨质疏松的检出率。检出率的比较采用χ2检验。结果所有受检者中,常规DXA检测髋部及腰椎前后位诊断出骨质疏松患者58例（58/76,76.3%）,侧位骨密度联合VFA诊断出骨质疏松患者76例（76/76,100%）,二者检出率差异有统计学意义（χ2=10.617,P < 0.001）。其中,股骨颈骨密度诊断骨质疏松疏检出率（55.3%）高于髋部整体（34.2%）,二者差异有统计学意义（χ2=6.812,P < 0.05）;髋部骨密度、腰椎前后位骨密度、腰椎侧位骨密度和VFA诊断骨质疏松症检出率分别为60.5%、47.4%、84.2%和78.9%,腰椎侧位骨密度与VFA的骨质疏松检出率比较,差异无统计学意义（χ2=0.700,P>0.05）,但二者均高于髋部骨密度的骨质疏松检出率（χ2=10.66、6.110,均P < 0.05）。结论DXA检测腰椎侧位骨密度联合VFA对老年性骨质疏松的诊断具有重要价值,能够避免骨质疏松的漏诊。     

The clinical role of dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA) measurements of hip and spine bone mineral density (BMD) have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of anti-fracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organisation (WHO) T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.     

不同DEXA测量股骨头骨矿的比较

目的 评估不同双能X线吸收测量仪(DEXA)的准确性及不同扫描条件对测量值的影响。方法 取6个人体切除的股骨头作为实验标本。分别以Hologic QDR-2000及Aloka DCS-3000 DEXA,在不同的扫描条件下(分别在4cm的有机玻璃板上、水深5cm、10cm、15cm、20cm、25cm及30cm)对实验标本进行骨矿测量。最后将股骨头标本放入马福炉内,在700℃高温下焚化24 h。取出灰化的6个标本,分别称重。并与其DEXA测量值做比较性研究。结果 BMC值与灰重的相关关系显示,在无水条件下,Hologic及Aloka双能X线吸收测量仪BMC测量值与灰重都明显相关。Hologic QDR-2000机(r=0.965～0.996)优于Aloka DCS-3000(r=0.823～0.964),尤其是随水深增加,前者的优越性就更为突出。结论 两种不同厂家生产的DEXA都可为骨矿定量提供可靠的准确性。Hologic QDR-2000机测量股骨头BMC值与灰重明显相关,其优越性大于Aloka DCS-3000 DEXA。随水深增加,前者较后者测量的准确性就更为明显。     

Alcoholism-associated spinal and femoral bone loss in abstinent male alcoholics,as measured by dual X-ray absorptiometry

Although alcoholism is a known risk factor for osteoporosis, there are few published reports on alcoholism-associated bone loss. To study alcoholism-associated bone loss, this study used a dual X-ray absorptiometry (DXA) densitometer to measure lumbar and femoral bone mineral density (BMD) in a previously little-studied population: 32 relatively healthy, nonhospitalized, Caucasian, alcoholic men with a period of abstinence longer than that previously studied (median abstinence 4.0 months, range 3 days–36 months). DXA is a new, highly precise densitometric method with many advantages over the methods used in previous studies. The subjects had statistically significant bone loss at three sites: lumbar spine, femoral neck, and Ward's triangle (multiple correction adjusted two-tailed P < 0.008). Compared to the mean BMD of sex-, age-, and race-matched norms, the subjects' average femoral neck, Ward's triangle, and lumbar BMDs were, respectively, 0.56, 0.69, and 0.57 standard deviations (SDs) below the normative values.This study was partially funded by a National Institutes of Health Short Term Research Training Grant (PHSHL 07491) to K.C.     

The correlation between dual-energy X-ray absorptiometry measures of bone density in the proximal femur and lumbar spine of children

 Objective. To assess the correlation between a pediatric patient’s proximal femur and lumbar spine bone mineral density (BMD) Z-scores, and the side-to-side difference between proximal femurs. Design. Three hundred and thirty-nine patients aged 2.2–17.0 years with an assortment of underlying conditions underwent dual-energy X-ray absorptiometry (DXA) measures of BMD in both proximal femurs and the lumbar spine. Results. Z-scores in the proximal femur and lumbar spine correlated highly (r=0.73, P=0.0001), but for individual patients the difference was often significant, and increased as BMD deviated further from normal. For patients with proximal femur Z-scores of 1 to –1 the mean difference between proximal femur and lumbar spine Z-scores was 0.5; with proximal femur Z-scores of less than –3 the mean difference was increased to 1.7. In conditions which symmetrically involve the lower extremities, the right and left proximal femur Z-scores differed on average by only 0.2. Conclusion. BMD measurements for pediatric patients are most easily interpreted by clinicians if converted to Z-scores, yet these are usually available only for the lumbar spine. Age-normalized BMD assessment at more than one site is necessary to provide a more reliable, complete assessment of bone mineral status in pediatric patients.     

Variation between femurs as measured by dual energy X-ray absorptiometry (DEXA)

It is commonly assumed that there is minimal variation between the hips in an individual, but is densitometry of one femur representative of the other? We performed bone mineral density (BMD) measurements of both hips using a Hologic QDR 1000 densitometer. There were 110 patients, all of whom were right handed, and three main groups of subjects: (1) normal volunteers (n = 36); (2) subjects with known hip pathology (n = 36); (3) subjects with medical conditions not affecting the hip (n = 38). The mean age of the subjects was 46 (21–87) years and a standard analysis protocol was followed in all patients. The coefficient of variation (COV) for femurs was 0.9–3%, depending upon the region studied and the BMD. The left femur had a greater BMD 48% of the time and there were variable differences between femurs in each group studied. While the greatest differences were found in people with unilateral hip pathology, all groups had mean differences greater than the COV It may be acceptable to study only one hip, but the large variation between femurs in individuals should be borne in mind when interpreting data.     

Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems

Two dual energy X-ray absorptiometric (DXA) instruments have recently become commercially available for local bone densitometry: the QDR-1000 (Hologic Inc.) and the DPX (Lunar Radiation Corp.). We report the precision, influence of femoral rotation, correlation and agreement of bone mineral measurements of the proximal femur by these two instruments. In vitro (femur phantom) short-term precision was 1.1%–3.5%, and the long-term precision was 1.2%–3.8%. In vivo (groups of 10 premenopausal and 10 postmenopausal women) short-term precision of duplicate measurements was 1.6%–4.7%, and long-term precision was 1.9%–5.5%. Overall, the precision for Ward's triangle was over 3% and that for the femoral neck and trochanter, 2%–3%. Rotation of a femur phantom produced a statistically significant change in the bone mineral density (BMD) of the femoral neck. Within a clinically relevant range of femoral rotation (20° inward rotation ±5°) the coefficient of variation (CV%) increased by a mean factor of 1.1–1.4. Although the correlation (r < 0.9) between BMD measurements of the proximal femur by the DPX and QDR-1000 in 30 postmenopausal women was high, there was lack of agreement between the two instruments. We found no statistically significant differences between the right and left femur in 30 postmenopausal women. A bilateral femur scan took a mean total time of about 22 min. We conclude that with the introduction of DXA instruments, the precision of bone mineral measurements of the proximal femur has improved. However, for comparability between commercially available DXA instruments, it might be advantageous if units were standardized. Offprint requests to: O.L. Svendsen     

Assess the discrimination of Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: Compared with dual energy X-ray absorptiometry measurements

Since the implementation of quantitative ultrasound (QUS) technology may become a part of future clinical decision making to identify osteoporosis and prevent fractures, this study was initiated to evaluate the correlations of QUS parameters and axial bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) and to assess the discrimination of QUS measurements for osteoporosis and osteopenia defined by WHO criteria. 106 native Chinese women (aged 50.2 ± 10.9 SD, 21-74 years) were involved. Each subject received both QUS measurements at left calcaneus with Achilles InSight and DXA measurements with DPX-L at lumbar spine (L_2-4), total hip and femoral neck. Achilles InSight provided the stiffness index (SI) which derived from Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS), and the T-scores of SI were calculated. We found that the QUS parameter SI was statistically significant but medium correlated (r = 0.458-0.587) with DXA at the lumbar spine, total hip and femoral neck (P < 0.0001 for all correlations). With ROC analysis, the area under the ROC curve of diagnosis of osteoporosis and osteopenia were 0.933 and 0.796, respectively. To identify osteoporosis, when the T-score threshold of SI was defined as −1.4, the sensitivity was 100%, and the specificity was 73.7%. Our study confirmed that QUS measurements performed with Achilles InSight were capable to identify osteoporosis defined by axial BMD using DXA in Chinese women.     

Bone mineral density evaluation o epileptic children on anti-epileptic medications

Objective

The aim of this work is to evaluate bone mineral density (BMD) in children with idiopathic epilepsy under anti-epileptic drugs and to determine the effect of the type and the duration of drug administration on BMD.

Digital X-ray radiogrammetry better identifies osteoarthritis patients with a low bone mineral density than quantitative ultrasound

This study assessed the ability of quantitative ultrasound (QUS) and digital X-ray radiogrammetry (DXR) to identify osteopenia and osteoporosis in patients with knee osteoarthritis (OA). One hundred and sixty-one patients with painful knee OA (81 men, 80 women; age 62.6±9.2 years, range 40–82 years) were included in this cross-sectional study and underwent dual-energy X-ray absorptiometry (DXA) of both hips and the lumbar spine, QUS of the phalanges and calcanei of both hands and heels, and DXR using radiographs of both hands. Unpaired t-test, Mann-Whitney U test, ROC analysis and Spearman’s rank correlation were used for comparisons and correlation of methods. Using DXA as the reference standard, we defined a low bone mineral density (BMD) as a T-score ≤−1.0 at the lumbar spine or proximal femur. In contrast to phalangeal or calcaneal QUS, DXR was able to discriminate patients with a low BMD at the lumbar spine (p<0.0001) or hips (p<0.0001). ROC analysis showed that DXR had an acceptable predictive power in identifying OA patients a low hip BMD (sensitivity 70%, specificity 71%). Therefore, DXR used as a screening tool could help in identifying patients with knee OA for DXA.     

A correlative study of ultrasound calcaneal and dual-energy X-ray absorptiometry bone measurements of the lumbar spine and femur in 1000 women

The objectives of the study were firstly to determine the accuracy of ultrasound calcaneal measurements in the prediction of bone mineral density determinations with dual-energy X-ray absorptiometry (DXA) of the lumbar spine (LS), femoral neck (FN), and Ward's triangle (FW) in a mixed population of 1000 women, unsorted as to diagnosis, and secondly to determine the accuracy of the various site-specific measurements in predicting each other. Ultrasound measurements [stiffness, speed of sound (SOS) and broadband ultrasound attenuation (BUA)] were made with the Lunar Achilles device, and the bone mineral density (BMD) of the LS, FN and FW were determined with the Lunar DPX. The data were analyzed for correlation, sensitivity, specificity, and accuracy of various paired sites. The coefficients of correlation of the young adultt-scores in the total group between calcaneal stiffness and BMDs of the LS, FN, and FW varied between 0.53 and 0.60. Coefficients for LS versus IN and FW were 0.70 and 0.62, respectively. A comparison of SOS and BUA values obtained at the calcaneus with BMDs of the LS, FN and FW yielded correlation coefficients that varied from 0.54 to 0.56. The general accuracy of prediction of one site by another ranged from 64.2% to 74.4%, where normality was defined as at-score >–2. It is concluded that no site can predict the status of another site with sufficiently high accuracy to be clinically useful. The role of ultrasound transmission in bone as a predictor of fracture risk is theoretically promising, but has yet to be proved by a long term prospective study.     

Comparison of dual photon and dual energy X-ray bone densitometers in a clinic setting

In clinical practice, decisions must be made about whether and how to convert to newer technologies. To address this issue, two separate studies were conducted. We evaluated the relationships between results of lumbar spine measurements using two dual photon absorptiometry (DPA1 and DPA2) instruments and one dual energy X-ray (DXA) instrument with the same subjects (49 volunteers), and also in 65 patients who were measured on the DPA1 and DXA machines. Second, we measured the lumbar spine and the proximal femur in three groups of 12 female volunteers three times on one instrument within 1 week. We purposely simulated a busy clinic setting with different technologists, older radioactive sources, and a heterogeneous patient group. The comparison study indicated a significant difference between the mean bone density values reported by the machines, but the results were highly correlated (R ² = 0.89–0.96). The short-term precision errors (coefficients of variation) differed among the instruments, ranging from 1.3% (DXA of the spine) to 5.1% (DPA1 of the spine), and in the femoral neck, 2.3% and 2.4% (DXA and DPA1, respectively) versus 3.5% by DPA2. This study emphasizes the differences between instruments, the potential for greater error in busy clinic environments, and the apparent superiority of dual energy X-ray absorptiometry under these less than ideal conditions.     

Bone mineral density reference values in the normal female and male population of Izmir,Turkey

In this study we aimed to establish the dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) reference values of healthy Turkish women and men residing in Izmir, western Turkey. We examined 347 women and 119 men (age range 20-80 years) who did not have any known risk factor that might affect bone mass. The BMD measurements were performed by Hologic QDR 4500 W Elite DXA instrument from the lumbar spine (L1-L4) and non-dominant hip. In women the mean BMD (g/cm(2))+/-standard deviation (SD) of the normal reference group between 20 and 39 years of age was 0.963+/-0.121 g/cm(2) in the lumbar spine and 0.891+/-0.119 g/cm(2) in total femoral region. The percentages of annual and total BMD losses in women between 30 and 80 years of age were 0.74 and 29% at spinal level and 0.65 and 26% in femoral region, respectively. The average BMD of the normal men's group between 20 and 39 years of age was 0.996+/-0.111 g/cm(2) in the lumbar spine and 1.025+/-0.110 g/cm(2) in femoral region. The percentages of annual and total BMD losses were 0.33 and 13% at spinal level and 0.50 and 20% in femoral region, respectively. In conclusion, like the values reported from mid-Anatolian region of Turkey, the BMD values of Turkish women and men residing in Izmir, western Anatolia, are also lower than in most European countries with regard to US and preinstalled Hologic values.     

Assessment of the bone mineral density in the lumbar vertebrae of newborns by quantitative computed tomography

 Objective. To assess the true mineral density (BMD, in g/cm³) of the lumbar spine in newborns. Design and patients. A post-mortem analysis of five infants with gestational ages ranging from 35 to 40 weeks, and birth weights from 2765 to 3200 g, was conducted using dual-energy quantitative computed tomography (QCT; Siemens Somatom DR). A 2 or 4 mm thick slice was obtained for each lumbar vertebra from L1 to L4. The density measured in these vertebrae was corrected by reference to a solid phantom (Osteo-CT) measured simultaneously. A three-dimensional image of the spine (Elscint CT Twin), as well as a photomicrograph of histological preparation from L2 vertebra, were also obtained in another term baby for comparison with the CT results. Results and conclusions. In the range of values studied, the vertebral densities were not dependent on birth weight. BMD values measured in L2, L3 and L4 were not significantly different, but were 10% lower than in L1 in four of five infants. The spatial resolution of the QCT protocol used (0.4 mm) did not permit the differentiation of trabecular and cortical bone, and the vertebral bodies appeared very homogeneous and dense, with a mean density value of 210±30 mg Ca/cm³, which is 2.5 times higher than the mean maximum value found in young normal adults. These preliminary results highlight the potential of QCT in neonatology. Special protocols will, however, need to be developed for in vivo measurements in this particular paediatric field.     

Bone mineral density reference values in the normal female and male population of İzmir, Turkey

In this study we aimed to establish the dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) reference values of healthy Turkish women and men residing in İzmir, western Turkey. We examined 347 women and 119 men (age range 20–80 years) who did not have any known risk factor that might affect bone mass. The BMD measurements were performed by Hologic QDR 4500 W Elite DXA instrument from the lumbar spine (L1–L4) and non-dominant hip. In women the mean BMD (g/cm²)±standard deviation (SD) of the normal reference group between 20 and 39 years of age was 0.963±0.121 g/cm² in the lumbar spine and 0.891±0.119 g/cm² in total femoral region. The percentages of annual and total BMD losses in women between 30 and 80 years of age were 0.74 and 29% at spinal level and 0.65 and 26% in femoral region, respectively. The average BMD of the normal men's group between 20 and 39 years of age was 0.996±0.111 g/cm² in the lumbar spine and 1.025±0.110 g/cm² in femoral region. The percentages of annual and total BMD losses were 0.33 and 13% at spinal level and 0.50 and 20% in femoral region, respectively. In conclusion, like the values reported from mid-Anatolian region of Turkey, the BMD values of Turkish women and men residing in İzmir, western Anatolia, are also lower than in most European countries with regard to US and preinstalled Hologic values. Electronic Publication     

Total and regional bone mineral content in healthy Spanish subjects by dual-energy X-ray absorptiometry

Design  This is an observational cross-sectional study. Objective  The aim of the present study was to describe and analyze patterns of change in total and regional bone mineral content in relation to age and gender in a sedentary Spanish sample population (from the Community of Madrid). The age range of the sample population was from birth to 80 years. Materials and methods  One thousand one hundred twenty healthy subjects were recruited and divided into 16 groups according to age. Each subject underwent whole-body densitometry using dual-energy X-ray absorptiometry. An analysis was made of the amount of bone mineral content (BMC) in the whole body and in different regions: the head, trunk, upper limbs, and lower limbs. Results  Gender differences in mean values for upper limbs and lower limbs are statistically significant between 16 and 70 years of age. For the head and trunk, the mean BMC values show the most significant gender differences between 16 and 25 years of age (p ≤ 0.001). Total bone mineral content (TBMC) and TBMC-to-height ratio show significant gender differences between 16 and 70 years of age. In females, TBMC values increase up to 20 years of age and in males up to 25 years of age. Conclusion  We have determined an evolutionary normal pattern of bone mineral content in urban Spanish people.     

Bone mineral density and bone scintigraphy in children and adolescents with osteomalacia

In order to demonstrate the role of bone mineral density (BMD) measurement and bone scans in the management of patients with osteomalacia, radioisotope bone scintigraphy using technetium-99m methylene diphosphonate (MDP) and BMD measurements of the lumbar spine and femur by means of dual X-ray absorptiometry (DXA) were performed at the time of diagnosis and 6 months after therapy in 26 Saudi patients (17 females and nine males). Their mean age was 13.5 years (range, 5–16). BMD measurements were compared with those of normal Saudi subjects matched for age and sex. Bone scan showed an increase in tracer uptake throughout the skeleton (“superscan”) in all children and demonstrated multiple stress fractures in eight. The mean BMD for the lumbar spine was 0.53 g/cm² (Z-score, −3.1) and for the femoral neck 0.55 g/cm² (Z-score, −2.8). Repeated bone scan and BMD after 5 months of therapy with oral vitamin D, calcium and proper sun exposure demonstrated a significant increase (P<0.001) in BMD and healing of pseudofractures. In conclusion, as a non-invasive method with minimal radiation exposure, measurements of BMD in children with osteomalacia are to be recommended in the initial assessment of the severity of osteopenia and in the follow-up to monitor the response to therapy. Bone scintigraphy is valuable in demonstrating the site and severity of stress fractures.     

Evaluation of mandibular bone mineral density using the dual-energy X-ray absorptiometry technique in edentulous subjects living in an endemic fluorosis region

Objectives

Fluoride is one of the biological trace elements with a strong affinity for osseous, cartilaginous and dental tissue. The dental and skeletal effects of high fluoride intake have already been studied in the literature, but little is known about the effects of high fluoride intake on edentulous mandibles. The purpose of this study was to evaluate the effects of high fluoride intake on mandibular bone mineral density (BMD) measured by the dual-energy X-ray absorptiometry (DXA) technique in edentulous individuals with systemic fluorosis.

Methods

32 people who were living in an endemic fluorosis area since birth and 31 people who were living in a non-endemic fluorosis area since birth (control group) participated in this study. Systemic fluorosis was diagnosed in the patients using the sialic acid (NANA)/glycosaminoglycan (GAG) ratio. The BMDs of the mandibles were determined by the DXA technique.

Results

The serum NANA/GAG ratios in the fluorosis group were significantly lower than those in the control group (p < 0.001). There was also a statistically significant difference in mandibular BMD measurements (p < 0.05) between the systemic fluorosis and control groups, as measured by the DXA technique. Mandibular body BMD measurements were higher in the fluorosis group (1.25 ± 0.24 g cm⁻²) than in the control group (1.01 ± 0.31 g cm⁻²).

Conclusions

The results of the study showed that fluoride intake higher than the optimum level causes increased mandibular BMD in edentulous individuals. Further dose-related studies are needed to determine the effects of high fluoride intake on bony structures of the stomatognathic system.     

Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices

Objectives

The aim of this study was to evaluate maxillary, mandibular and femoral neck bone mineral density using dual energy X-ray absorptiometry (DXA) and to determine any correlation between the bone mineral density of the jaws and panoramic radiomorphometric indices.

Methods

49 edentulous patients (18 males and 31 females) aged between 41 and 78 years (mean age 60.2 ± 11.04) were examined by panoramic radiography. Bone mineral density (BMD) of the jaws and femoral neck was measured with a DXA; bone mineral density was calculated at the anterior, premolar and molar regions of the maxilla and mandible.

Results

The mean maxillary molar BMD (0.45 g cm⁻²) was significantly greater than the maxillary anterior and premolar BMD (0.31 g cm⁻², P < 0.05). Furthermore, the mean mandibular anterior and premolar BMD (1.39 g cm⁻² and 1.28 g cm⁻², respectively) was significantly greater than the mean mandibular molar BMD (1.09 g cm⁻², P < 0.01). Although BMD in the maxillary anterior and premolar regions were correlated, BMD in all the mandibular regions were highly correlated. Maxillary and mandibular BMD were not correlated with femoral BMD. In addition, mandibular cortical index (MCI) classification, mental index (MI) or panoramic mandibular index (PMI) values were not significantly correlated with the maxillary and mandibular BMDs (P > 0.05).

Conclusions

The BMD in this study was highest in the mandibular anterior region and lowest in the maxillary anterior and premolar regions. The BMD of the jaws was not correlated with either femoral BMD or panoramic radiomorphometric indices.