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Mandibular bone changes in 24 years and skeletal fracture prediction.

Journal article
Authors Grethe Jonasson
Valter Sundh
Magnus Hakeberg
Azar Hassani-Nejad
Lauren Lissner
Margareta Ahlqwist
Published in Clinical Oral Investigations
Volume 17
Issue 2
Pages 565-572
ISSN 1432-6981
Publication year 2013
Published at Institute of Odontology
Institute of Medicine, School of Public Health and Community Medicine
Pages 565-572
Language en
Keywords Bone structure, Epidemiology, Fracture, Mandible, Osteoporosis, Longitudinal cohort, Radiography, Women
Subject categories Dentistry, Public Health, Global Health, Social Medicine and Epidemiology, Other Medical Sciences


OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.

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