Fractal Dimension Analysis and Radiomorphometric Indices as Predictors for Low Bone Mineral Density in Postmenopausal Women: A CBCT-Based Study.

OBJECTIVES: This study assessed mandibular cone-beam computed tomography (CBCT) radiomorphometric indices and box-counting fractal dimension (FD) for the detection of osteoporosis in postmenopausal women. It also compared these parameters with those of a healthy control group and evaluated their correlation with bone mineral density measured using dual-energy X-ray absorptiometry (DXA). METHODS: The study included 50 postmenopausal women aged > 45 years, who were categorized into osteoporotic and control groups based on DXA results. Mandibular CBCT radiomorphometric indices and FD analysis were performed. RESULTS: Significant differences were observed in the CT cortical index, with Type 3 changes more frequently in the osteoporotic group (48.0%), whereas Type 1 morphology was predominant in controls (64.0%) (P < 0.001). Mean values were significantly lower in osteoporotic participants (0.24 ± 0.05, 0.29 ± 0.06, and 3.37 ± 0.53, respectively) compared with controls (0.29 ± 0.06, 0.35 ± 0.07, and 4.05 ± 0.46, respectively) (P ≤ 0.002). Fractal dimension value was significantly higher in the osteoporotic group (1.98 ± 0.01 vs. 1.96 ± 0.01, P < 0.001). Receiver operating characteristic analysis showed that an FD cutoff value of > 1.976 yielded 72.0% sensitivity and 100.0% specificity for distinguishing individuals with osteoporosis. CONCLUSIONS: CBCT radiomorphometric indices may serve as a useful adjunct for identifying individuals at risk of osteoporosis and for guiding referral for further evaluation.