Dental X-rays to detect osteoporosis?
What could be easier, more convenient and cheaper than to check for osteoporosis as part of having a standard dental radiograph done? It might be possible according to a recent study. See: Bone. 2004 Aug;35(2):403-11, Faber TD and others, Fourier and wavelet analyses of dental radiographs detect trabecular changes in osteoporosis. PMID: 15268890. The authors hypothesized that individuals with osteoporosis would exhibit an altered radiographic trabecular pattern that could be detected by spatial frequency and strut analysis. To test this they took maxillary and mandibular radiographs of 26 women with osteoporosis and 23 controls examining by using one-dimensional discrete fourier and wavelet analyses in both jaws to measure the spatial frequency distributions of trabecular structures. They also did a strut analysis. Results showed individuals with osteoporosis had an altered trabecular pattern compared to controls. With Fourier and strut variables there was classification of subjects with 92% sensitivity (probability of a positive test among patients with disease), and 96% specificity (probability of a negative test among patients without disease). Thus it appears this type of spatial frequency analysis of digitized dental radiographs may be valuable for identifying individuals with osteoporosis. (Comments: This is a preliminary study, but it if follow-up studies produce similar results, this could be a very important way to diagnose osteoporosis).
HA-coated screws for osteoporotic trochanteric fractures
This study is really directed to orthopedic physicians who repair hip fractures, but the results appear to be so significant that I want to mention them so men with osteoporosis will know what ideal fracture treatment is. See: Clin Orthop. 2004 Aug:(425):87-92, Moroni A. and others. HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures. PMID: 15292892. In summary the authors found that when HA-coated fixation screws were used to repair hip fractures in osteoporotic patients there were no failures. HA (hydroxyapatite) is a component of bone and probably allows for an actual bond between the screw and the bone to account for these good results. (Comments: The important point here is that if you or anyone you know has an osteoporotic hip fracture, it is important that you realize that HA-coated screws should be used in the repair. You'll need to discuss this with the surgeon to be sure he/she is using the ideal hip screw. Also, note that very often orthopedic surgeons don't assume the patient has osteoporosis after a fracture. You might need to use some simple logic to determine that until diagnostic tests can be done later. Basically that would mean fracture in an at-risk (often older) individual after a low-trauma event. Often the individual actually falls due to the fracture, and the fracture is not the result of the fall).
Early MRI of suspected hip fractures
This study suggests that there are some cases of suspected osteoporotic hip fracture where the X-ray is unable to detect the problem, but an MRI can be effective in locating the fracture or finding some other cause of the pain. See: Hong Kong Med J. 2004 Aug;10(4):271-5, Lee YP and others. Early magnetic resonance imaging of radiographically occult osteoporotic fractures of the femoral neck. PMID: 15299173. The authors followed 28 patients over a 3-year period who had no apparent hip fracture on X-ray, but who had subsequent MRI within a 48-hour period. The MRI revealed radiographically occult neck fractures in 50% of the cases (equivalent to 4% of all femoral neck fractures). When no femoral neck fracture was present, magnetic resonance imaging revealed an alternative cause for symptoms in all 14 cases. The authors, ". . .strongly endorse the use of early magnetic resonance imaging for patients with osteoporosis who have a clinically suspected femoral neck fracture that is not visible radiographically." (Comments: Once again this study is directed to physicians, but patients need to be aware of possible medical solutions to problems they have. If you feel you've had a fracture but the X-ray is negative, you must be sure you get an early MRI to either find the occult fracture or the other true cause of the problem).