The effect of bisphosphonates on mandibular radiomorphometric indeces and bone density in post-menopausal osteoporosis patients

Osteoporosis is the structural failure of the bone, characterized by a reduction in bone mass, deterioration in microstructure and increased risk of bone fragility. Osteoporosis, a systemic skeletal disease, affects the density and structure of jaw bones. Alveolar bone resorption, especially in the mandible, is a major problem facing dentists by affecting the retention, stabilization, support and chewing function of dental prostheses. It is extremely important to know the quality of the jaw bone and the structural changes in the bone in terms of treatment planning and prognosis in dentistry. Bisphosphonates are potent inhibitors of bone resorption frequently used in bone metabolism disorders. Bisphosphonates are used for multiple myeloma, Paget's disease, bone metastases, malignancy-related hypercalcemia and pediatric bone diseases. They are also preferred as the first choice in the medical treatment of osteoporosis. Considering that many people visit the dentist at least once a year, it is foreseen that the oral and maxillofacial region is examined more clinically and radiologically than the other regions of the body, and therefore the radiological examination of this region can give an idea in the early diagnosis of osteoporosis or follow the treatment. We aimed to have an idea about the effects of bisphosphonates on the mandibular bone by examining the mandibular radiomorphometric indices and mandibular bone density of patients who were diagnosed with postmenopausal osteoporosis referred to our Oral and Maxillofacial Surgery Polyclinic and who did or did not receive bisphosphonate treatment. In this respect, we also aimed to increase awareness of dentists' approach to osteoporosis patients and to share information between dentists and physicians who regulate osteoporosis treatment. Sixty female patients were enrolled in the study between the ages of 45-70 who had previously been diagnosed with postmenopausal osteoporosis. There are no diseases affecting bone metabolism in the patients. Two groups were formed from the patients. In the first group, 30 patients using bisphosphonates and in the second group, 30 patients who did not use bisphosphonates (control group) were included. Digital panoramic radiographs of the patients were taken and mental index and mandibular cortical indices, two of mandibular radiomorphometric indices, were measured on radiographs. All body DEXA records were taken to calculate the bone mineral density of the spine and mandible of the patients. There was a statistically significant difference in spine bone mineral density in patients using bisphosphonates compared to patients who did not use them (p=0,043) . There was no statistically significant difference between mandibular bone mineral density and mental indeces and mandibular cortical indeces between patients who use bisphosphonate and who did not use bisphosphonate. While the rate of mental indices to determine the risk of osteoporosis was 76.7%, the rate of mandibular cortical indices to determine the risk of osteoporosis was calculated as 91.7. Bisphosphonates have increased bone mineral density in the spine. The use of bisphosphonates did not make any difference in mandibular parameters (mandibular bone mineral density, mandibular cortical indices and mental indices). Dentists may play a role in the early diagnosis of osteoporosis using mental indices and mandibular cortical indeces on panoramic radiographs. Key words: dental panoramic radiography, mandibula, radiomorphometric indices, postmenoposal osteoporosis, biphosphonate, dexa