The role of dental radiographs in assessing bone mineral density: a systematic review of literature.

Abstract

Bone mineral density (BMD) is a critical indicator of skeletal health, with implications for systemic conditions such as osteoporosis and localized oral diseases. Dental radiographs, routinely employed in clinical practice, offer a non-invasive means to assess bone quality, yet their role in quantifying BMD and diagnosing metabolic bone disorders remains underexplored. This systematic review of literature examines the diagnostic efficacy of dental radiographs in evaluating BMD. A comprehensive analysis of existing studies in databases such as PubMed, Scopus, Web of Science, ScienceDirect, and SpringerLink was conducted to identify patterns, methodologies, and gaps in the current understanding of radiographic bone assessment for early detection of osteoporosis. The search covered studies published between January 2001 and August 2025, utilizing a search string including "Dental Radiographs" [Mesh] OR "Panoramic Radiography" [Mesh] OR "Periapical Radiography" OR "Cone-Beam Computed Tomography" [Mesh])AND ("Bone Mineral Density" [Mesh] OR "Osteoporosis" [Mesh]) AND ("DXA" OR "Dual-Energy X-ray Absorptiometry" [Mesh]) AND ("Correlation" OR "Assessment" OR "Evaluation"). Database searching yielded 1,247 records relevant to the study objective. After duplicate removal and meticulous screening, 17 studies met the inclusion criteria and were included in the review. The findings of the reviewed studies indicate that dental radiographs, particularly panoramic and periapical imaging, show moderate correlation with dual-energy X-ray absorptiometry (DXA) in detecting osteoporosis. However, precision varies with imaging technique and anatomical region. Quantitative analyses of trabecular patterns and cortical thickness further suggest that dental radiographs can serve as supplementary tools for early BMD screening, especially in high-risk populations. However, inconsistencies in diagnostic thresholds and limited standardization across studies highlight the need for further research. This review underscores the potential of dental radiographs as accessible screening tools, while emphasizing the need to refine analytical protocols to enhance their reliability in clinical and research settings.