Correlations between the Mandibular Angle and Mandibular Ratio Indices and the 10-year Probability of Osteoporotic Fracture Estimated Using the Fracture Risk Assessment Tool Body Mass Index Calculator

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Abstract
Background: Osteoporosis significantly impacts public health, especially in older adults and postmenopausal women, by increasing fracture risk due to reduced bone density. With dual-energy X-ray absorptiometry facing accessibility issues, this study explores alternative screening methods through panoramic radiographs, assessing the mandibular angle (MA) and mandibular ratio (MR) as potential osteoporosis indicators. This research investigates their correlation with a 10-year osteoporotic fracture risk using the Fracture Risk Assessment Tool (FRAX) Body Mass Index (BMI) method. Objective: The objective of this study was to investigate the correlation between the measurement of the MA, the MR on a panoramic radiograph, and the probability of a 10-year risk of osteoporotic fractures based on the FRAX BMI tool. Methods: The study analyzed 422 panoramic radiograph images from patients aged 40–89 years, including both genders. MR was calculated by the ratio of the mandibular body’s height to the distance from the mandible’s lower edge to the mental foramen. MA was determined through the MA measurement. The FRAX BMI method, accounting for BMI and fracture risk factors, assessed the 10-year risk for major osteoporotic and hip fractures. Results: Findings reveal no significant correlation between MR and MA indices with osteoporotic fracture risk, suggesting their limited effectiveness as predictive tools for such fractures. This outcome indicates the necessity for more reliable osteoporosis risk assessment methods. Conclusions: Combining FRAX BMI with MR and MA indices may provide additional information in the context of the overall health of the patient and age-related pathologies in the mandible. However, the primary role in assessing osteoporosis risk remains with the FRAX BMI tool, due to its ability to consider multiple relevant factors of osteoporotic fracture risk. The MR and MA indices can be helpful as supplementary diagnostic tools, but their role in directly predicting osteoporosis appears to be limited.

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