{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:53:37Z","timestamp":1791140017624,"version":"4.1.0"},"reference-count":65,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical &amp; Exp Dental Res"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Osteoporosis is a silent systemic skeletal disease characterized by microarchitectural deterioration and increased fracture risk; thus, early case\u2010finding is essential. Although dual\u2010energy X\u2010ray absorptiometry (DEXA) is the reference standard for bone mineral density (BMD) assessment, limited accessibility and cost restrict its use for large\u2010scale screening. Given that cone\u2010beam computed tomography (CBCT) is routinely obtained in dental practice, image\u2010derived parameters\u2014gray value (GV) and fractal dimension (FD)\u2014may provide insight into their association with systemic bone mineral density measured by DEXA in postmenopausal women, without additional radiation exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      This cross\u2010sectional study included 63 postmenopausal women aged 50\u201370 years undergoing dental CBCT (NewTom 3G; standardized acquisition). Six trabecular regions of interest (ROIs) were evaluated: mandibular retromolar, mandibular premolar, mandibular anterior (central), maxillary premolar, maxillary anterior (central), and maxillary tuberosity. GV values were extracted using OnDemand3D\u2010Dental from standardized 25\u2009\u00d7\u200925\u2010pixel ROIs positioned to exclude cortical bone and dental structures. FD was calculated in ImageJ using a box\u2010counting method following Gaussian blur subtraction, binarization, and skeletonization. Lumbar spine and hip BMD were measured by DEXA and categorized according to WHO criteria. Statistical analyses included\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests\/ANOVA, Pearson correlation (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u2009=\u20090.05). Intra\u2010observer reliability was assessed with intraclass correlation coefficients (ICC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      DEXA classified 49.2% as normal, 34.9% as osteopenic, and 15.9% as osteoporotic. Lumbar assessment identified more non\u2010normal cases than the hip evaluation. Reliability was good (ICC\u2009&gt;\u20090.70). Although mean GV and FD did not differ significantly between groups, site\u2010specific GV\u2013FD correlations were observed. Notably, FD at the maxillary premolar correlated with lumbar T\u2010scores in the non\u2010normal group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While GV and FD did not discriminate BMD categories overall, region\u2010dependent associations between CBCT\u2010derived parameters and systemic BMD were observed, suggesting potential clinical relevance in dental imaging. These exploratory findings should not be interpreted as diagnostic or screening indicators and require confirmation in larger studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cre2.70474","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:40:16Z","timestamp":1791139216000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Site\u2010Specific Associations Between CBCT\u2010Derived Gray Value and Fractal Dimension and DEXA T\u2010Scores in Postmenopausal Women: A Cross\u2010Sectional Analytical Study"],"prefix":"10.1002","volume":"12","author":[{"given":"Golnoush","family":"Saeidi","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Radiology, Dental School Hamadan University of Medical Sciences Hamadan Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4434-4634","authenticated-orcid":false,"given":"Mohammad Mahdi","family":"Maleki","sequence":"additional","affiliation":[{"name":"Student Research Committee, Hamadan University of Medical Sciences Hamadan Iran"},{"name":"Dental Implants Research Centre, Dental School, Hamadan University of Medical Sciences Hamadan Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3434-3672","authenticated-orcid":false,"given":"Abbas","family":"Shokri","sequence":"additional","affiliation":[{"name":"Professor, Dental Implants Research Center, Department of Oral and Maxillofacial Radiology, Dental School Hamadan University of Medical Sciences Hamadan Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4378-3143","authenticated-orcid":false,"given":"Leili","family":"Tapak","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health\u2014Modeling of Noncommunicable Diseases Research Center, Institute of Health Sciences and Technologies Hamadan University of Medical Sciences Hamadan Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"391","volume-title":"Osteoporosis in Men. 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