Assessing Osteoporosis Risk on Panoramic Radiography through Fractal Dimension Analysis of Mandibular Condyles in Postmenopausal Women

Abstract The study aimed to analyze the trabecular bone structure pattern of the condylar bone on panoramic radiography using fractal dimension (FD) analysis and to identify the correlation between FD and bone mineral density (BMD) values to assess osteoporosis risk in postmenopausal women. This study involved 150 panoramic radiographs of postmenopausal women aged ≥50 years who were diagnosed with normal, osteopenia, and osteoporosis based on BMD values. FD analysis was performed on the condylar bone to establish standard FD values for normal, osteopenia, and osteoporosis conditions. The analysis was performed on the condylar bone using the box-counting method in ImageJ software to obtain FD values from skeletonized binary images of 30 × 30 pixel regions of interest (ROIs) on both condylar heads. The normality of the data was assessed using the Shapiro–Wilk test, and correlations between variables were evaluated using Spearman's rank correlation analysis. There was a significant positive correlation (p < 0.001) between FD and BMD values, with moderate correlation strength (r = 0.462 for ROI 1 and r = 0.518 for ROI 2). Higher BMD values were associated with higher FD values, and vice versa. Low FD values indicated low trabecular bone density (osteoporosis), while higher FD values reflected better trabecular bone density (normal). FD analysis of the mandibular condyles can serve as an indicator of osteoporosis. It complements BMD by quantifying trabecular bone structural changes, offering a method for early osteoporosis detection.