Introduction Osteoporosis is a metabolic disease characterized by reduced bone mineral density, often accompanied by loss of quality of trabecular bone microarchitecture. Objective To assess the quality or degradation of trabecular bone microarchitecture in digital panoramic radiography to better predict the risk of fragility fractures. Material and method The sample included 68 female patients, age-matched, and divided into three groups according to densitometric results. Trabecular Bone Score values were measured and digital panoramic radiographs were taken. Fractal analysis with box counting was conducted in the region of premolars and angle of the mandible, with regions of interest measuring 64×64 and 80×120 pixels. In the statistical analysis, Pearson’s correlation was applied between the Trabecular Bone Score and fractal analysis results obtained in each group, using age as a control variable and assigning individualized age ranges within groups. Result A moderate correlation was identified in the regions of interest of 64×64 and 80×120 pixels at the angle of the mandible in the osteoporosis group and in the normal group. A moderate correlation was also obtained using age as a control variable in the 64x64 pixel regions of interest in the premolar region. Considering age range, the within-group analysis presented a strong correlation in the osteoporosis group and moderate correlation in the osteopenia and normal groups. Conclusion Fractal analysis in digital panoramic radiographs was shown to be a promising predictive instrument of bone microarchitecture quality.