Evaluation of clinical and radiographic indices as predictors of osteoporotic fractures: a 10-year longitudinal study

Publication date: Available online 21 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Grethe Jonasson, Valter Sundh, Magnus Hakeberg, Margareta Ahlqwist, Lauren Lissner, Dominique Hange
ObjectivesTo evaluate two radiographic and three clinical indices as predictors of future osteoporotic fractures.Study designIn a prospective, longitudinal study with a 10-year fracture follow-up, the two radiographic indices, mandibular cortical erosion (normal, mild/moderate erosion, and severe erosion of the inferior cortex) and cortex thickness, were assessed using panoramic radiographs of 411 women, aged 62-78 years. The clinical indices were the fracture assessment tool, FRAX^(R), the osteoporosis index of risk, OSIRIS, and the osteoporosis self-assessment tool, OST.ResultsThe relative risks (RR) for future fracture were significant for FRAX^(R)>15%, 4.1 (95% CI: 2.4-7.2), and for severely eroded cortices, 1.7 (95% CI: 1.1-2.8). Cortical thickness <3mm, OSIRIS, and OST were not significant fracture predictors (RR 1.1, 1.4, and 1.5 respectively). For the five tested fracture predictors, Fisher's exact test gave the following p-values for differences between fractured and non-fractured groups: FRAX^{( R)} <0.001, cortical erosion 0.023, OST 0.078, OSIRIS 0.206, and cortical thickness 0.678. The area under the curve (AUC) was 0.69 for FRAX^(R)>15%, 0.58 for cortical erosion, and 0.52 for cortical thickness. Adding OSIRIS and OST did not change AUC significantly.ConclusionFRAX^(R) and severely eroded cortices predicted fracture but cortical thickness, OSIRIS, and OST did not.



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