The Jaw-X IO method uses intraoral digital X-rays to assess bone quality. The method is based on image analysis of the trabechular structure of the jaw bone, visible between the premolars in the lower jaw in a common dental X-ray image.
A recent clinical study in Sweden in 5 clinics shows very high accuracy. The result show that 95% of a group of patients (women 55+) that has been tested as "at risk" with Jaw-X were also tested positive for osteoporosis/osteopenia with DEXA.
Jaw-X IO is patented by Crebone AB. US Patent No. 7848551.
The patent is available for sale or can be licensed to software manufacturers.
Please contact Crebone AB for more information.
Phone
+46(0)8-6210700
Email
info@jaw-x.com
Quick facts
Osteoporosis is characterized by low bone mass, bone fragility and a greater risk for fracture. It is often called a "silent" disease because it has no discernable symptoms. Like other tissues in the body, bone tissue is in a state of constant flux - remodeling and rebuilding. There are many influences on bone formation and strength, such as hormones, physical exercise and diet (especially intake of calcium, phosphate, vitamin D, and other nutrients). Osteoporosis occurs when there are problems with these factors, resulting in more bone loss than bone rebuilding.
The Surgeon General's Report on Osteoporosis and Bone Health, released in November 2004, estimates that 34 million Americans are at risk for osteoporosis. At the launch of "Bone Health and Osteoporosis: A Report of the Surgeon General," Surgeon General Richard H. Carmona, M.D., M.P.H., F.A.C.S., suggested that we need to be educated about osteoporosis and aware of what we can do to prevent it. "With healthy nutrition, physical activity every day, and regular medical check-ups and screenings, Americans of all ages can have strong bones and live longer, healthier lives."
Fragility fractures caused by osteoporosis have become one of the most prominent national health problems in the western world. E.g. Sweden and other European countries. Each year approximately 70,000 fractures occur in Sweden, with a population of 9 million, of which 17,000 are hip fractures costing around $25,000 each during the first post-operational year. This represents a considerable cost for the Swedish Health Department, and requires more days of healthcare than for patients with diabetes and patients with cardiac/circulatory diseases.
Approved preventive medical treatment is available, but very few persons with osteoporosis are actually diagnosed and treated. Even though every patient with osteoporosis does not sustain fractures, their risk of fracture is much higher due to lower bone density and poor bone mass. Bone mass and bone density can be measured in various ways. One method used by physicians is to measure bone density using Dual X-ray absorptiometry (DXA). It is a major problem that half of all women over 50 years of age and one fourth of all men in this age group risk having fragility fractures, but physicians only have opportunity to examine and provide care for a very small percentage of the population.
Definition
Osteoporosis has been defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures" (Consensus Development Conference Statement 1991). There is, at this point, no consensus regarding the various causes of osteoporosis. Internationally accepted diagnostic criteria for osteoporosis have been provided by a group of experts within the World Health Organization (WHO). However, these operational criteria are limited to women patients, is primarily based on measurements of the hip, back and forearm, and are based entirely upon bone density values:
Examination and diagnostics
The diagnosis of osteoporosis, according to WHO, is determined by bone density measurement. Several methods for such measurements exist. WHO’s diagnostic definition currently encompasses only DXA and SXA methods which use measurements of the hip, back and forearm for women patients.
DXA (dual energy X-ray absorptiometry) is the most common technique today. It is based, like SXA, on the use of an X-ray tube as the radiation source where two energy values from X-ray radiation are measured. DXA technique is used clinically for measuring bone mineral content in the lumbar, hip and, in some cases, for full skeletal measurements. Some equipment can even measure full body composition. In the lower spine the L1-L4 or L2-L4 vertebrae are measured, and upper spinal measurements are taken of the neck (anatomical area "collum"). Measurements of Ward’s triangle and the trochanter are also performed.
Who should be examined?
A follow up article regarding an SBU rapport from 1995 (Johnell, Sääf Läkartidning 1999,
Sweden) addresses the issue regarding when bone mass examinations should be made. The conclusion was that bone density measurements are recommended for persons under 65 years of age who exhibit some
of the following risk factors. For persons over 65 years of age, ANY of the following risk factors warrant a bone mass examination.
Summary
In practical clinical terms this means that there is a strong basis for performing bone density measurements in order to identify persons with potential fracture danger, especially persons who are at high risk such as those identified with diminished bone structure using normal X-rays.
Odontological research
Dentists have been monitoring jawbone density for many years in order to understand why resorbtion occurs in toothless areas of the jaw at different rates for different patients and to evaluate bone quality before replacing extracted teeth with implants. Bone density has been measured primarily in the lower jaw to see how it correlates with measurements from other skeletal areas.
A study by Jonasson et al. used Lindh et al.’s classification method and compared the bone structure of the lower jaw with the bone density in the forearm. 80 women age 20-78 were classified into various osteoporosis risk groups. Of these, 12 women had dense bone structure in the lower jaw and normal bone density in the forearm. Twenty-five women had diminished bone structure in the lower jaw, (what about the forearm measurements for this group of 25?) and all of these except 2 were diagnosed with osteopenia or osteoporosis. The remaining women hade alternating dense and attenuated bone structure. Eleven women who were in this latter group were identified with "focal osteoporotic bone marrow defects" and had osteopenia or osteoporosis. The connection between DXA measurements in the forearm and in the trabecular structure of the jaw were statistically very significant. (r = 0.62, p & lt; 0,001)
Clinically, it was possible to identify the high risk and low risk groups referring to the bone density of the forearm, but it was also possible by studying the jawbone structure using a normal dental X-ray.
"Osteodent", a study at multiple centers under the auspices of the EU, has shown that this correlation can be established through analysis of the trabecular structure of the lower jaw or the width of the mandibular corticalis using dental X-rays.
The Method
Based on the conclusions of the Osteodent project a software program have been developed which uses intraoral images of a defined region in the lower jaw (mandible) to measure trabecular density in the bone. The resulting measurement values from these images are analyzed using the standard threshold value for Osteoporosis defined by WHO.
The program has been evaluated using patients who participated in the EU Osteodent project (approx 150 of 600 in Malmö, Sweden). The image measurements together with the use of a simple questionnaire (patient history information regarding risk factors) provides an osteoporosis risk analysis with very high specificity
The method involves the analysis of bone quality using an intraoral X-ray. The measurement results are analyzed together with a few anamnestic variables and a report is generated indicating one of three risk categories:
The method has been tested clinically in a current scientific project with a number of participating dentists.
Jaw-X is patented
Jaw-X IO is patented by Crebone AB. US Patent No. 7848551.
References
Original referenceComments papers:
Summary of: The role of the dental surgeon in detecting osteoporosis: the
OSTEODENT study
Richard Lloyd
SUMMARY: Objective To determine if thinning (<3 mm
width) of the lower cortical border of the mandible on dental panoramic
radiographs, as well as other
CONTEXT: H.Devlin, P.Allen, J.Graham, R.Jacobs,
K.Nicopoulou-Karayianni, C.Lindh, E.Marjanovic, J.Adams, S.Pavitt, P.van der
Stelt and K.Horner British Dental Journal 2008; 204: E16 Editor's summary This
interesting study suggests an addition to...
BDJ 204, 560 - 561 (24 May 2008), doi: 10.1038/sj.bdj.2008.427
Dentists could detect osteoporosis
CONTEXT: ...way of identifying osteoporosis sufferers
from ordinary dental radiographs. Professor Keith Horner and Dr Hugh Devlin
co-ordinated a three year, EU-funded collaboration with the Universities of
Athens, Leuven, Amsterdam and Malmo, to...
BDJ
202, 59 - 59 (27 Jan 2007), doi: 10.1038/bdj.2007.55, News
General references:
Consensus development conference. Prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.
Statens beredning för medicinsk utvärdering (2003). Osteoporos-prevention, diagnostik och behandling. SBU Stockholm, Sweden.
J.E. Compton. "Action Plan for the Prevention of Osteoporotic Fractures in the European Community". Osteoporosis International vol. 15, pp 259-262, 2004.
The Surgeon General's Report on Osteoporosis an Bone Health, November 2004.
Osteoporosis manifestation in jawbone
Crawford BF, Weathers DR: Osteoporotic marrow defects of the jaws. J Oral Surg 1970;28:600-3.
Klemetti E, Vainio P, Lassila V, Alhava E: Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women. Scand J Dent Res 1993;101:219-23.
Horner K, Devlin H, Alsop CW, Hodgkinson IM, Adams JE: Mandibular bone mineral density as a predictor of skeletal osteoporosis. Br J Radiol 1996;69:1019-25.
Lindh C, Peterson A, Rohlin M: Assessment of the trabecular pattern before endosseous implant treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod 1996;82:335-43.
S.C. White: "Oral Radiographic Predictors of Osteoporosis" Dentomaxillofacial Radiology, vol. 31, pp 84-92, 2002.
Jonasson, G (2005). Mandibular Alveloar Bone Mass, Structure and Thickness in relation to Skeletal Bone Density in Dentate Women. Department of Orthodontics, Faculty of Odontology. Gothenburg 2005.
Methodology
P.D. Allen, J. Graham, J.J. Farnell, E.J. Harrison, R. Jacobs, K. Karayianni, C. Lindh, P.F. van der Stelt, K. Horner, H. Devlin.
"Detecting reduced bone mineral density from dental radiographs using statistical shape models"
K. Karayianni, K. Horner, A. Mitsea, L. Berkas, M. Mastoris, R. Jacobs, C. Lindh, P. F. vzn der Stelt, E. Harrison, J. E. Adams, S. Pavitt and H.Devlin:
"Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): The OSTEODENT project." Bone 2006.
Karl Johan Andersson: Method and system for analysis of bone density. US patent nr 11/552998; 2006.10.26