Cortical bone thickness of the distal radius predicts the local bone mineral density

Aims The distal radius is a major site of osteoporotic bone loss resulting in a high risk of fragility fracture. This study evaluated the capability of a cortical index (CI) at the distal radius to predict the local bone mineral density (BMD). Methods A total of 54 human cadaver forearms (ten singles, 22 pairs) (19 to 90 years) were systematically assessed by clinical radiograph (XR), dual-energy X-ray absorptiometry (DXA), CT, as well as high-resolution peripheral quantitative CT (HR-pQCT). Cortical bone thickness (CBT) of the distal radius was measured on XR and CT scans, and two cortical indices mean average (CBTavg) and gauge (CBTg) were determined. These cortical indices were compared to the BMD of the distal radius determined by DXA (areal BMD (aBMD)) and HR-pQCT (volumetric BMD (vBMD)). Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC) were used to compare the results and degree of reliability. Results The CBT could accurately be determined on XRs and highly correlated to those determined on CT scans (r = 0.87 to 0.93). The CBTavg index of the XRs significantly correlated with the BMD measured by DXA (r = 0.78) and HR-pQCT (r = 0.63), as did the CBTg index with the DXA (r = 0.55) and HR-pQCT (r = 0.64) (all p < 0.001). A high correlation of the BMD and CBT was observed between paired specimens (r = 0.79 to 0.96). The intra- and inter-rater reliability was excellent (ICC 0.79 to 0.92). Conclusion The cortical index (CBTavg) at the distal radius shows a close correlation to the local BMD. It thus can serve as an initial screening tool to estimate the local bone quality if quantitative BMD measurements are unavailable, and enhance decision-making in acute settings on fracture management or further osteoporosis screening. Cite this article: Bone Joint Res 2021;10(12):820–829.

Mandibular cortical index in the screening of postmenopausal at low mineral density risk: a systematic review

Objectives: This systematic literature review addressed the use of mandibular cortical index (MCI), assessed by panoramic radiography, for the identification of postmenopausal women at risk of osteoporosis. Methods: Databases were searched for original research studies published from September 2010 to September 2020 using the following keywords: “postmenopausal osteoporosis” and synonyms combined with “panoramic radiography” and synonyms. Only English language manuscripts and studies pertaining to the MCI were selected. Results: A total of 24 studies were included. The publications were highly heterogeneous in terms of the subject of interest, i.e. the MCI, with some studies comparing the usefulness of the MCI using panoramic radiography and using cone beam computed tomography, and others comparing different radiomorphometric indexes developed for panoramic radiography. Conclusions: Based on the literature included in this systematic review, we conclude that the MCI is useful as an auxiliary tool for identifying postmenopausal females at risk of low bone mineral density (BMD), as it correlates with skeletal BMD measured by dual X-ray absorptiometry. Nevertheless, other radiomorphometric indexes obtained from panoramic radiographs, such as panoramic mandibular index, mental index, and mandibular cortical width, are also valuable as auxiliary tools in the identification of postmenopausal females at risk, as they also correlate with BMD. Thus, it is not possible to affirm which index is the most reliable for the identification of postmenopausal females considering the literature screened. PROSPERO registration systematic review CRD42020208152.

A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty

Background During the last decades, the growing number of shoulder replacement has increased the associated complications. Periprosthetic fractures have a low incidence but can be a severe clinical condition, especially in elderly population. There are still no guidelines to define the best treatment protocol for post-operative periprosthetic humeral fractures. Factors associated to these fractures and consequently the decision-making for the best treatment seem to be patient-related but also correlated with the type of implant. The aim of this study is to analyze the patient’s risk factors, fracture pattern, implant type and treatment, evaluating the outcome with a long-term follow-up. Methods A retrospective study was performed on more than 2700 shoulder prostheses implanted over 10 years in two specialized centers, identifying 19 patients who underwent surgery for post-operative periprosthetic fracture. Gender, age, comorbidities, type of prosthetic implant, type of fracture, and cortical index of each patient were evaluated. All patients underwent surgery and were evaluated with a mean follow-up of 5 years with radiographic controls and functional assessment with the Constant–Murley score. Results Complete healing was achieved in 18 of 19 patients. All patients presented a lower Constant–Murley score than the pre-fracture score, there were no significant differences between prosthetic implants, and the cortical index was lower than the threshold level in more than 60% of cases. Conclusion The results of this study showed that a correct preoperative planning is essential to evaluate the type of implant and possible signs of stem mobilization. With a stable stem, it is preferable to maintain it and proceed to a synthesis. The decision process is more complex in periprosthetic fractures with a reduced cortical index, when some radiolucency lines are present in stems with high primary stability, because it is not always indicative of an unstable stem. Level of Evidence Therapeutic III

Do HIV patients have mandibular osteoporotic alterations? A mandibular cortical index case-control study

Objective: The objective of this study was to evaluate mandibular osteoporotic alterations in patients with HIV infection in comparison to non-HIV-infected patients using panoramic radiographs. Material and Methods: 26 HIV-infected patients and 142 non-HIV-infected patients (control group) were included in this study. Panoramic radiographs of the participants were assessed considering mandibular cortical index (MCI). Non-parametric comparisons between groups were performed, using Mann-Whitney test, at a level significance level of p= 0.05. Results: HIV-infected patients presented lower bone mineral density (BMD) at mandible, assessed by MCI in panoramic radiographs when compared to non-HIV-infected patients. The medication intake of HIV-infected patients was highly heterogeneous and could not be associated to the low BMD presented in the mandibular cortex. Conclusions: HIV-infected patients may present lower mandibular BMD than non-HIV-infected patients. Keywords Panoramic radiograph; osteoporosis; bone mineral density; HIV.

MANDIBULAR BONE QUALITY OF PANORAMIC RADIOGRAPHS IN HIV-INFECTED CHILDREN

Background: People living with HIV may have several pathologic conditions in its body and bone is one of the organs affected by HIV infection. HIV-infected patients have been associated frequently with osteoporosis and lower bone mineral density (BMD) which may lead to the increasing risk of bone fracture. This situation may become more complicated in children and young age as it will affect the long-term bone quality and development later in life until the peak BMD is reached. Objectives: The aim of this study was to measure the mandibular bone quality using the mandibular cortical index (MCI) and panoramic mandibular index (PMI) in panoramic radiographs of HIV-infected children. Method: This study used descriptive cross sectional research design which analyzed panoramic radiographs of HIV-infected children and measured its mandibular bone quality. Total 43 panoramic radiographs of HIV-infected children were observed and analyzed qualitatively using mandibular cortical index (MCI) and panoramic mandibular index (PMI) were used for the quantitave measurement, as it have been widely used for assesing mandibular bone quality in previous studies. Mandibular cortical index (MCI) has 3 categories of cortical bone quality: C1 (normal cortex), C2 (mildly to moderately eroded cortex), and C3 (severely eroded cortex), while the normal ratio of mental foramen-inferior border of mandible to mandibular cortical length in panoramic mandibuIar index is about 0.3. Result: Mandibular cortical index (MCI) of 43 HIV-infected children consist of 4 samples in C1, 38 in C2, 1 in C3, while the panoramic mandibular index (PMI) of 43 HIV-infected children consist of 23 less than normal, 5 normal, 15 more than normal. Conclusions: The most number of mandibular cortical index (MCI) was C2 (mildly to moderately eroded cortex) and the most number of panoramic mandibular index (PMI) was less than normal of HIV-infected children.

RADIOMORPHOMETRIC EVALUATION OF MANDIBULAR CORTICAL INDEX AMONG YOUNG AND MIDDLE-AGED LITHUANIAN INDIVIDUALS

Background and objective. The aim of this study was morphological analysis of the cortical layer in the mandibular base distally from the mental foramen for determination of the mandibular cortical index in the Lithuanian young and middle-aged individuals according to gender, age, general health status, used medicine. Materials and methods. The study included 216 randomly selected subjects aged 19 to 50 years. A questionnaire was used to collect data on subjects’ age, gender, sociodemographic status, diseases, and used medicines, harmful habits. Skeletal bone status was examined according One – Minute test, panoramic radiography was performed, and panoramic radiographic images were analyzed to determine the mandibular cortical index. According to the classification by Klemetti, subjects were divided into 3 index morphological groups: C1, C2, and C3. Analysis was carried out by mentioned factors. Results. There was a significant relationship between mandibular cortical index and subject’s age (F=4.54; df=2; p=0.01), gender (χ2=16.22; df=2; p<0.01), thyroid diseases (p=0.05), hormonal preparation use (p<0.01), cigarette smoking (p<0.01). Conclusions: The study data confirmed the hypothesis that morphological changes in the cortical layer at the mandibular base were found among young and middle aged individuals with normal skeletal bone status and were significantly associated with subject’s age, gender, and other factors such as cigarette smoking, diseases having an influence on bone metabolism, used medicines.