Comparison of the effect of oral and intravenous bisphosphonate use on bone density in the jaws in osteoporosis patients using fractal analysis method

Aim: In our study; we aimed to learn the effects of bisphosphonate use duration and route of administration on mandibular cortical and trabecular bone in women over 50 years of age using bisphosphonates for postmenopausal osteoporosis, and to evaluate the place of dental panoramic radiograms in the early diagnosis of osteoporosis. Materials and Method: 90 postmenopausal individuals over the age of 50 were included in our study. Group I; healthy individuals (n=30), II. Group; osteoporosis patients using oral bisphosphonates (n=30), III. Group; Osteoporosis patients using intravenous (IV) bisphosphonates (n=30) were grouped as. Each group was divided into 2 subgroups according to the presence of molar teeth in the posterior region. Trabecular bone density was determined numerically by fractal analysis method in the relevant regions (ROI) selected on the panoramic radiogram. The width of the cortical bone (MCW) under the mental foramen of the mandible was measured. Obtained data were evaluated statistically. Results: According to the findings, fractal dimension (FB) values of toothed and edentulous individuals using oral or intravenous bisphosphonates were lower in every region measured compared to healthy individuals. Again, regardless of the type of drug use, it was observed that the mandibular cortical bone thickness of the patients using both oral and IV bisphosphonates was significantly lower than the healthy individuals. Although the FB values of toothed individuals using oral bisphosphonates and toothed individuals using IV bisphosphonates were close to each other, significantly lower results were obtained in patients using oral bisphosphonates in the two selected ROI regions. Although similar values were obtained in edentulous patients, we found that patients using oral bisphosphonates in only one region had a significantly lower value than patients using IV bisphosphonates. Although there was no significant difference in mandibular cortical thickness measurements, it was observed that individuals using oral bisphosphonates had lower MCW values than individuals using IV bisphosphonates, regardless of whether they were toothed or edentulous. No significant correlation was found between the duration of use of bisphosphonates and the fractal values obtained from the relevant regions of the mandible. Conclusions: Our results suggest that the use of intravenous bisphosphonates plays an important role in achieving a better bone gain in the trabecular and cortical bones of the mandible. We argue that the measurement of MCW values, as an important marker in osteoporosis patients, should be used as an important diagnostic tool in the early diagnosis of patients and directing them to the necessary departments.