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Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly

Halling, A; Persson, GR; Berglund, Johan LU ; Johansson, O and Renvert, S (2005) In Osteoporosis International 16(8). p.999-1003
Abstract
Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below) 1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants ( 102 men and 109 women) 60 - 96 years in the SNAC-Blekinge study ( Swedish National... (More)
Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below) 1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants ( 102 men and 109 women) 60 - 96 years in the SNAC-Blekinge study ( Swedish National Study on Ageing and Care) underwent bone densitometry [ by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as '0' or normal ( even and sharp endosteal margin), '1', moderately eroded ( evidence of lacunar resorption or endosteal cortical residues), or '2', severely eroded ( unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below -1.5 SD was 8.04 (95% CI 2.39 to 27.12, P< 0.001) in the 'osteopenic' (KI category 2), compared with the 'normal' group ( KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia ( KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding ( KI category < 2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
panoramic, Klemetti index, osteoporosis, radiography
in
Osteoporosis International
volume
16
issue
8
pages
999 - 1003
publisher
Springer
external identifiers
  • wos:000230625500019
  • pmid:15605191
  • scopus:23744500102
ISSN
1433-2965
DOI
10.1007/s00198-004-1796-x
language
English
LU publication?
yes
id
b996de74-28d9-403a-a65a-0fc14a28b3d6 (old id 232222)
date added to LUP
2007-08-07 14:03:11
date last changed
2017-11-19 04:04:29
@article{b996de74-28d9-403a-a65a-0fc14a28b3d6,
  abstract     = {Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below) 1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants ( 102 men and 109 women) 60 - 96 years in the SNAC-Blekinge study ( Swedish National Study on Ageing and Care) underwent bone densitometry [ by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as '0' or normal ( even and sharp endosteal margin), '1', moderately eroded ( evidence of lacunar resorption or endosteal cortical residues), or '2', severely eroded ( unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below -1.5 SD was 8.04 (95% CI 2.39 to 27.12, P&lt; 0.001) in the 'osteopenic' (KI category 2), compared with the 'normal' group ( KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia ( KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding ( KI category &lt; 2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements.},
  author       = {Halling, A and Persson, GR and Berglund, Johan and Johansson, O and Renvert, S},
  issn         = {1433-2965},
  keyword      = {panoramic,Klemetti index,osteoporosis,radiography},
  language     = {eng},
  number       = {8},
  pages        = {999--1003},
  publisher    = {Springer},
  series       = {Osteoporosis International},
  title        = {Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly},
  url          = {http://dx.doi.org/10.1007/s00198-004-1796-x},
  volume       = {16},
  year         = {2005},
}