Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep-Oct;15(5):1077-1082.
doi: 10.1016/j.jobcr.2025.06.025. Epub 2025 Jul 22.

Investigating anterior and posterior alveolar trabecular patterns on periapical radiographs: Insights into bone mineral density in postmenopausal women

Rurie Ratna Shantiningsih  1   2 , Rini Widyaningrum  1   2 , Silviana Farrah Diba  2 , Adioro Soetojo  3 , Aga Satria Nurrachman  1 , Eha Renwi Astuti  1
Affiliations

Investigating anterior and posterior alveolar trabecular patterns on periapical radiographs: Insights into bone mineral density in postmenopausal women

Rurie Ratna Shantiningsih et al. J Oral Biol Craniofac Res. 2025 Sep-Oct.

Abstract

Background: The increasing aging population places postmenopausal women at higher risk of osteoporosis due to reduced bone mass. While Dual-Energy X-ray Absorptiometry (DXA) is the standard for measuring Bone Mineral Density (BMD), its cost and limited availability drive the need for alternative methods. Fractal Dimension (FD) analysis of trabecular bone patterns in periapical radiographs offers a cost-effective and accessible approach. This study examines FD differences in anterior and posterior mandibular regions as a potential early marker for osteoporosis in postmenopausal women.

Materials & methods: A cross-sectional study analyzed periapical radiographs from 31 postmenopausal women with BMD and T-score data from DXA scans. FD analysis measured alveolar bone density (ABD) and D values in the anterior and posterior regions. One-way ANOVA tested regional differences, while Spearman's and Pearson's correlation assessed relationships between FD values, BMD, and T-score.

Results: No significant differences were found between anterior and posterior ABD and D values (p > 0.05). ABD showed a significant positive correlation with BMD (r = 0.383, p < 0.05), while D values did not. The T-score correlated significantly with anterior ABD (r = -0.357, p < 0.05).

Conclusion: Although no significant regional FD differences were found, ABD in periapical radiographs, particularly in the anterior region, may serve as a potential indicator for osteoporosis risk in postmenopausal women.

Keywords: Alveolar bone; Anterior region; Bone density; Health care; Medicine; Periapical radiographs.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Image processing on the periapical radiograph to represent ABD dan D Value: (A1) Original ROI image of posterior region; (A2) Original ROI image of anterior region; (B) duplicated image of ROI; (C) Subtracted of Gaussian blur sigma 2; (D) Filter added 128 Gy; (E) Converted to binary image; (F) Reduced noise by Erode Binary; (G) Reduced noise by Dilate Binary; (H1) Transformed to binary outline; (H2) Transformed to skeletonize binary.
Fig. 2
Fig. 2
Representative examples of anterior and posterior alveolar bone trabecular patterns in different bone conditions. (A) Original periapical radiographic image; (B) Binarized image highlighting trabecular area; (C) Skeletonized image illustrating trabecular structure. Rows represent bone condition groups: normal, osteopenia, and osteoporosis. Columns show anterior (left) and posterior (right) alveolar regions. Each image set shows a progression from raw radiograph to processed analyses for visual comparison across conditions for D Value Analysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Guralnik J.M., Balfour J.L., Volpato S. The ratio of older women to men: historical perspectives and cross-national comparisons. Aging Clin Exp Res. 2000;12(2):65–76. doi: 10.1007/bf03339893. - DOI - PubMed
    1. Christensen K., Doblhammer G., Rau R., Vaupel J.W. Ageing populations: the challenges ahead. 2009;374(9696):1196–1208. doi: 10.1016/S0140-6736(09)61460-4. - DOI - PMC - PubMed
    1. Muramatsu C., Horiba K., Hayashi T., et al. Quantitative assessment of mandibular cortical erosion on dental panoramic radiographs for screening osteoporosis. Int J Comput Assist Radiol Surg. 2016;11(11):2021–2032. doi: 10.1007/s11548-016-1438-8. - DOI - PubMed
    1. Camargo A.J., Côrtes A.R.G., Aoki E.M., Baladi M.G., Arita E.S., Watanabe P.C.A. Analysis of bone quality on panoramic radiograph in osteoporosis research by fractal dimension. Appl Math. 2016;7:375–386. doi: 10.9734/bpi/nramcs/v8/7403f. - DOI
    1. Yasaka K., Akai H., Kunimatsu A., Kiryu S., Abe O. Prediction of bone mineral density from computed tomography: application of deep learning with a convolutional neural network. Eur Radiol. 2020;30(6):3549–3557. doi: 10.1007/s00330-020-06677-0. - DOI - PubMed

LinkOut - more resources