Aspects of osteoporosis and fracture risk assessment in primary dental care: attitudes, willingness to pay and evaluation of an automated software

Abstract

In study III, five raters assessed and, after four weeks, reassessed participants' risk of osteoporosis in the intraoral radiographs using semiautomated software. Radiographs were also assessed by the software's fully-automated tool for analysis. Overall interrater agreement for the five raters was 0.37 (95% CI 0.32-0.41), and for the five raters with the fully-automated tool included as 'sixth rater' the overall Kappa was 0.34 (0.30-0.38). Intrarater agreement varied from moderate to substantial according to the Landis&Koch [1977] interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis, which is T-score values for the spine, total hip and femoral neck and presented in the form of sensitivities, specificities, predictive values, likelihood ratios, and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40.4% (range 14.3%-57.6%). Corresponding values for specificity was 69.5% (range 59.7%-90.4%). The diagnostic odds ratios ranged between 1 and 2.7. The conclusion drawn from study III was that the low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimize the automation of trabecular pattern analysis in intraoral radiographs.Since osteoporosis is only one of the risk factors for fragility fractures, in study IV, we investigated the predictive value of the semi-automated and fully-automated analysis of the trabecular pattern in intraoral radiographs for risk of fracture when other clinical risk factors such as age, body mass index, previous fracture, heredity, smoking, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and alcohol intake were taken into account. The results from automated trabecular pattern analysis were also compared to study participants' TBS values in the search for correlation. Neither the semi-automated nor the fully-automated assessment of trabecular pattern in intraoral radiographs showed the predictive value for fragility fracture. The correlation with TBS was rather weak and was only present for the semi-automated software.