{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:02:07Z","timestamp":1780556527698,"version":"3.54.1"},"reference-count":53,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Osteoporosis is highly relevant to dentistry, oral surgery, and implantology. Because panoramic radiographs are routinely acquired in dental practice, they may enable opportunistic pre-screening. This pilot study evaluated established radiomorphometric indices on orthopantomograms (OPGs) and introduced a new qualitative index, the Mini Osteoporosis Pre-Screening (MOPS) index, based on the appearance of the cervical vertebral bodies visible on panoramic radiographs. Methods: This retrospective study analyzed 40 pseudonymized patient datasets, each including both OPG and dual-energy X-ray absorptiometry (DXA) examinations. DXA findings served as the reference standard in the study group. In addition 80 OPG scans from a control group of young adults without clinical or anamnestic evidence of osteoporosis were assessed. Two independent examiners with backgrounds in radiology and dentistry evaluated four indices: mandibular cortical width (MCW), panoramic mandibular index (PMI), mandibular cortical index (MCI), and MOPS. Results: Relative to the reference standard, MOPS demonstrated diagnostic accuracy ranging from 83% to 100% across selected groups. In women, accuracy ranged from 90% to 100%, with a sensitivity of 1.0 and specificity of 0.9. MCI and MOPS were more robust than MCW, whereas PMI showed limited applicability in routine clinical images. Conclusions: Panoramic radiographs can show osteoporosis-related changes in the mandible and cervical spine. MOPS offers a rapid, cost-neutral pre-screening method and may help dentists identify patients who warrant DXA referral. Larger prospective studies are needed to confirm its clinical utility.<\/jats:p>","DOI":"10.3390\/diagnostics16111728","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:04:12Z","timestamp":1780553052000},"page":"1728","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Osteoporosis Diagnostics in Dental Radiology (Panoramic Radiograph): The Mini Osteoporosis Pre-Screening (MOPS)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7041-6592","authenticated-orcid":false,"given":"Margrit-Ann","family":"Geibel","sequence":"first","affiliation":[{"name":"Dento-Maxillofacial Radiology, Department of Maxillofacial Surgery, University Hospital Ulm, 89070 Ulm, Germany"},{"name":"Department Genderspecific Dentistry, Danube University, 3500 Krems an der Donau, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5299-5142","authenticated-orcid":false,"given":"Amina Maria","family":"Geibel","sequence":"additional","affiliation":[{"name":"Department of Oral Surgery, University Center for Dental Medicine Basel UZB, 4058 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7523-1979","authenticated-orcid":false,"given":"Meinrad","family":"Beer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89070 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilmann","family":"Blasenbrey","sequence":"additional","affiliation":[{"name":"Dento-Maxillofacial Radiology, Department of Maxillofacial Surgery, University Hospital Ulm, 89070 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Kildal","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89070 Ulm, Germany"},{"name":"Radiology, Upper Valais Hospital Center (SZO), H\u00f4pital du Valais, 3900 Brig, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","first-page":"57","article-title":"12-month prevalence of osteoporosis in Germany","volume":"2","author":"Fuchs","year":"2017","journal-title":"J. Health Monit."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4103\/jmh.JMH_21_17","article-title":"Association between Dental Health and Osteoporosis: A Study in South Indian Postmenopausal Women","volume":"8","author":"Kapoor","year":"2017","journal-title":"J. Mid-Life Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105883","DOI":"10.1016\/j.jbspin.2025.105883","article-title":"Association between osteoporosis and periodontitis","volume":"92","author":"Tilotta","year":"2025","journal-title":"Jt. Bone Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3109\/13697137.2010.500749","article-title":"Periodontitis and osteoporosis: A systematic review","volume":"13","author":"Machuca","year":"2010","journal-title":"Climacteric"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1741-2358.2005.00083.x","article-title":"The relationship between dietary intake and the number of teeth in elderly Japanese subjects","volume":"22","author":"Yoshihara","year":"2005","journal-title":"Gerodontology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1902\/jop.2013.120613","article-title":"Association between low bone mineral density and clinical attachment loss in Japanese postmenopausal females","volume":"84","author":"Iwasaki","year":"2013","journal-title":"J. Periodontol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1097\/gme.0b013e31823dbbf7","article-title":"Relationship between bone turnover biomarkers, mandibular bone mineral density, and systemic skeletal bone mineral density in premenopausal and postmenopausal Indian women","volume":"19","author":"Makker","year":"2012","journal-title":"Menopause"},{"key":"ref_8","first-page":"141","article-title":"Does an Osteoporosis-like Condition Jeopardize the Osseointegration Process Around Dental Implants Placed in Animal Models? A Systematic Review","volume":"40","author":"Kalil","year":"2025","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1007\/s00784-023-05005-2","article-title":"Do dental implants placed in patients with osteoporosis have higher risks of failure and marginal bone loss compared to those in healthy patients? A systematic review with meta-analysis","volume":"27","author":"Lemos","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00108-015-3791-z","article-title":"Aktuelle Osteoporoseprophylaxe und-therapie","volume":"56","author":"Bartl","year":"2015","journal-title":"Internist"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s001980050197","article-title":"Survival after hip fracture: Short- and long-term excess mortality according to age and gender","volume":"10","author":"Sogaard","year":"1999","journal-title":"Osteoporos. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"380","DOI":"10.7326\/0003-4819-152-6-201003160-00008","article-title":"Meta-analysis: Excess mortality after hip fracture among older women and men","volume":"152","author":"Haentjens","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_13","first-page":"154","article-title":"Economic burden of osteoporosis in the world: A systematic review","volume":"34","author":"Kemmak","year":"2020","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00223-015-0089-z","article-title":"Current and Future Incidence and Costs of Osteoporosis-Related Fractures in The Netherlands: Combining Claims Data with BMD Measurements","volume":"98","year":"2016","journal-title":"Calcif. Tissue Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00198-006-0206-y","article-title":"Epidemiology, treatment and costs of osteoporosis in Germany\u2014the BoneEVA Study","volume":"18","author":"Gothe","year":"2007","journal-title":"Osteoporos. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.14219\/jada.archive.2005.0084","article-title":"The potential role of dentists in identifying patients\u2019 risk of experiencing coronary heart disease events","volume":"136","author":"Glick","year":"2005","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.31661\/jbpe.v9i1Feb.743","article-title":"Mandibular Trabecular Bone Analysis Using Local Binary Pattern for Osteoporosis Diagnosis","volume":"9","author":"Khojastepour","year":"2019","journal-title":"J. Biomed. Phys. Eng."},{"key":"ref_18","unstructured":"WHO (1994). Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Report of a WHO Study Group, WHO."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/BF01622200","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report","volume":"4","author":"Kanis","year":"1994","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bartl, R. (2010). Osteoporose: Pr\u00e4vention, Diagnostik, Therapie, Thieme. [4th ed.].","DOI":"10.1055\/b-001-1073"},{"key":"ref_21","unstructured":"IOF International Osteoporosis Foundation (2026, April 02). Diagnosis: Diagnostic Criteria. Available online: https:\/\/www.osteoporosis.foundation\/health-professionals\/diagnosis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00259-024-06912-6","article-title":"Updated practice guideline for dual-energy X-ray absorptiometry (DXA)","volume":"52","author":"Slart","year":"2025","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_23","unstructured":"(2026, February 11). BFS Budensamt f\u00fcr Strahlenschutz. Available online: https:\/\/www.bfs.de\/DE\/themen\/ion\/anwendung-medizin\/diagnostik\/roentgen\/haeufigkeit-exposition.html#:~:text=Die%20H%C3%A4ufigkeit%20von%20R%C3%B6ntgenuntersuchungen%20in,90%20%25%20bei%20Kassenpatienten."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1097\/CORR.0000000000001295","article-title":"Classifications in Brief: The Dorr Classification of Femoral Bone","volume":"478","author":"Wilkerson","year":"2020","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Seki, K., Nagasaki, M., Yoshino, T., Yano, M., Kawamoto, A., and Shimizu, O. (2024). Radiographical Diagnostic Evaluation of Mandibular Cortical Index Classification and Mandibular Cortical Width in Female Patients Prescribed Antiosteoporosis Medication: A Retrospective Cohort Study. Diagnostics, 14.","DOI":"10.3390\/diagnostics14101009"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00198-005-2029-7","article-title":"Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis","volume":"17","author":"Taguchi","year":"2006","journal-title":"Osteoporos. Int."},{"key":"ref_27","first-page":"ZC36","article-title":"Relationship between femur bone mineral density, body mass index and dental panoramic mandibular cortical width in diagnosis of elderly postmenopausal women with osteoporosis","volume":"8","author":"Nagi","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0030-4220(91)90314-3","article-title":"Variations in adult cortical bone mass as measured by a panoramic mandibular index","volume":"71","author":"Benson","year":"1991","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/j.1600-0722.1994.tb01156.x","article-title":"Pantomography in assessment of the osteoporosis risk group","volume":"102","author":"Klemetti","year":"1994","journal-title":"Eur. J. Oral Sci."},{"key":"ref_30","unstructured":"(2026, April 01). Panoramic Radiography Positioning. Available online: https:\/\/materialbank.planmeca.com\/catalog\/Brochures\/r\/255\/viewmode=previewview\/fc=4%3A514."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11282-021-00518-6","article-title":"Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis","volume":"37","author":"Taguchi","year":"2021","journal-title":"Oral Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1259\/dmfr.25.5.9161180","article-title":"Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible","volume":"25","author":"Taguchi","year":"1996","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20190149","DOI":"10.1259\/dmfr.20190149","article-title":"The accuracy of panoramic radiography as a screening of bone mineral density in women: A systematic review","volume":"49","author":"Kinalski","year":"2020","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Canal-Mac\u00edas, M.L., Vera-Rodr\u00edguez, V., Leal-Hern\u00e1ndez, O., Calder\u00f3n-Garc\u00eda, J.F., Roncero-Mart\u00edn, R., Garc\u00eda-Bl\u00e1zquez, F., Rico-Mart\u00edn, S., L\u00f3pez-Espuela, F., Mor\u00e1n, J.M., and Fabregat-Fern\u00e1ndez, J. (2025). Association Between Mandibular Cortical Erosion and Bone Mineral Density Assessed by Phalangeal Ultrasound and Dual Energy X-Ray Absorptiometry in Spanish Women. Diagnostics, 15.","DOI":"10.3390\/diagnostics15040507"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101816","DOI":"10.1016\/j.artmed.2020.101816","article-title":"Automatic computation of mandibular indices in dental panoramic radiographs for early osteoporosis detection","volume":"103","author":"Aliaga","year":"2020","journal-title":"Artif. Intell. Med."},{"key":"ref_36","first-page":"e285","article-title":"Evaluation of jaw bone changes in patients with asthma using inhaled corticosteroids with mandibular radiomorphometric indices on dental panoramic radiographs","volume":"28","author":"Aytekin","year":"2023","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s11282-025-00803-8","article-title":"Radiomorphometric indices for measuring mandibular bone quality in oncologic patients","volume":"41","author":"Carneiro","year":"2025","journal-title":"Oral Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"17S","DOI":"10.1177\/0022034514554949","article-title":"Panoramic Measures for Oral Bone Mass in Detecting Osteoporosis: A Systematic Review and Meta-Analysis","volume":"94","author":"Calciolari","year":"2014","journal-title":"J. Dent. Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Pasler, F. (2008). Zahn\u00e4rztliche Radiologie, Thieme. [5th ed.].","DOI":"10.1055\/b-002-11344"},{"key":"ref_40","unstructured":"Whaites, E. (2009). Dental Radiography and Radiology, Churchill Livingstone."},{"key":"ref_41","first-page":"7","article-title":"Radiologische Diagnostik der Osteoporose","volume":"9","author":"Drisamer","year":"2002","journal-title":"J. Miner. Muskoloskelettale Erkrank."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00198-023-06949-7","article-title":"Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis\u2014Meta-analysis and systematic review","volume":"35","author":"Heuchert","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"S\u00e1ez-Chand\u00eda, J., Castillo-Quispe, S., Okamoto, K., Kurahashi, A., Kodaira, K., Aihara, K., Suzuki-Barrera, K., Kaku, M., Mikami, Y., and Terunuma, M. (2025). Effects of Freeze-Dried Sake Lees and Rice Koji Extract on Osteoporosis in a Postmenopausal Mouse Model. Nutrients, 17.","DOI":"10.3390\/nu17193077"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Poian\u0103, I.R., Burcea, I.F., Pi\u021buru, S.-M., and Bucur, A. (2024). Cone Beam Computed Tomography Panoramic Mandibular Indices in the Screening of Postmenopausal Women with Low Bone Mass: Correlations with Bone Quantity and Quality. Dent. J., 12.","DOI":"10.20944\/preprints202407.1874.v1"},{"key":"ref_45","unstructured":"DVO (2023). Leitlinie Prophylaxe, Diagnostik und Therapie der Osteoporose bei Postmenopausalen Frauen und M\u00e4nnern ab dem 50. Lebensjahr, DVO. Available online: https:\/\/leitlinien.dv-osteologie.org\/."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20160212","DOI":"10.1259\/dmfr.20160212","article-title":"Feasibility of cone beam computed tomography radiomorphometric analysis and fractal dimension in assessment of postmenopausal osteoporosis in correlation with dual X-ray absorptiometry","volume":"45","author":"Mostafa","year":"2016","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Poian\u0103, I.R., Dobre, R., Pi\u021buru, S.-M., and Bucur, A. (2024). The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study. J. Pers. Med., 14.","DOI":"10.3390\/jpm14080843"},{"key":"ref_48","unstructured":"Nackaerts, O. (2009). Validation and Diagnostic Performance of Jaw Bone Densitometry. [Ph.D. Thesis, Katholieke Universiteit Leuven]. Available online: https:\/\/omfsimpath.be\/onewebmedia\/ThesisOliviaNackaerts_01Apr09.pdf."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"20200514","DOI":"10.1259\/dmfr.20200514","article-title":"Mandibular cortical index in the screening of postmenopausal at low mineral density risk: A systematic review","volume":"50","author":"Munhoz","year":"2021","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_50","first-page":"318","article-title":"CBCT assessment of mandibular bone quality and quantity in patients with osteoporosis","volume":"127","author":"Stoica","year":"2023","journal-title":"Med.-Surg. J."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Geibel, M.-A., Turhani, D., Blasenbrey, T., Beer, M., and Kildal, D. (2025). The Early Detection of Osteoporosis Through the Measurement of Hard Palate Thickness (HPT) Using Dental Cone Beam Computed Tomography (CBCT): A New Indicator for Osteoporosis?. Diagnostics, 15.","DOI":"10.3390\/diagnostics15131603"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s00117-024-01318-9","article-title":"Thickness of the hard palate","volume":"64","author":"Kildal","year":"2024","journal-title":"Die Radiol."},{"key":"ref_53","unstructured":"Geibel, M.-A. (2021). Gender Dentistry: Grundlagen und Konsequenzen f\u00fcr den zahnmedizinischen Praxisalltag. Orale Medizin, Lehmanns Media."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1728\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:14:05Z","timestamp":1780553645000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111728"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111728","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}