Investigating anterior and posterior alveolar trabecular patterns on periapical radiographs: Insights into bone mineral density in postmenopausal women

Background: The increasing aging population places postmenopausal women at higher risk of osteoporosis due to reduced bone mass. While Dual-Energy X-ray Absorptiometry (DXA) is the standard for measuring Bone Mineral Density (BMD), its cost and limited availability drive the need for alternative methods. Fractal Dimension (FD) analysis of trabecular bone patterns in periapical radiographs offers a cost-effective and accessible approach. This study examines FD differences in anterior and posterior mandibular regions as a potential early marker for osteoporosis in postmenopausal women. Materials & methods: A cross-sectional study analyzed periapical radiographs from 31 postmenopausal women with BMD and T-score data from DXA scans. FD analysis measured alveolar bone density (ABD) and D values in the anterior and posterior regions. One-way ANOVA tested regional differences, while Spearman's and Pearson's correlation assessed relationships between FD values, BMD, and T-score. Results: No significant differences were found between anterior and posterior ABD and D values (p > 0.05). ABD showed a significant positive correlation with BMD (r = 0.383, p < 0.05), while D values did not. The T-score correlated significantly with anterior ABD (r = �0.357, p < 0.05). Conclusion: Although no significant regional FD differences were found, ABD in periapical radiographs, particularly in the anterior region, may serve as a potential indicator for osteoporosis risk in postmenopausal women. © 2025 Elsevier B.V., All rights reserved.