Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies

Abstract

Objectives: To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis. Methods: This registered systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy statement. High sensitivity search strategies were developed for six primary databases and grey literature. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty. Results: From 1034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate. Conclusions: This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.

Fractal characteristics of the trabecular pattern of the mandible in patients with renal transplantation

“…There are studies showing that FD values can be used to predict the presence of osteoporosis and that there is a significant correlation between them. 37,[45][46][47][48] In our study, we found FD values lower in RTx patients than in the healthy group. When the immunosuppressive agents used by the patients are evaluated, this situation can be clarified by the disorder in bone-mineral balance caused by these drugs.…”

“…As the duration of disease increased in RTx patients, the rate of osteoporosis increased. 37,39 This difference can be explained by the fact that the patients in our study had a longer disease state in terms of total duration. In a study conducted in 2016; FD values were found to be lower than the healthy control group in the evaluation performed with panoramic radiography in patients diagnosed with CKD.…”

“…Contrary to some studies, 32,33 which show an increase in FD value in some diseases that cause osteoporotic effects; many studies have shown that the FD value decreases in systemic diseases. 12,15,19,27,[34][35][36][37] In a study in which bone structure analysis was performed by computerized microtomography in cats with CKD; it has been shown that there is a lower bone volume in the trabecular bone. 38 Although different methods and calculations have been reported, the box-counting method for fractal analysis is the most preferred method.…”

Digital panoramic radiography as a tool for analyzing the quality of trabecular bone microarchitecture

“…We used FD in this research considering the measure's low execution complexity and the use of free software. We chose DPR for examination since it has been widely used in studies 29 and presents low execution complexity, high availability, and low cost, being a viable alternative for implementation in health services.…”

“…Differences related to ROIs are important in using FA. The selection area and size of these regions are greatly diverse since variations mainly consider mandible regions and shapes are mostly square or rectangular, with different sizes [29][30][31] .…”