Fractal Dimension Analysis of Mandibular Trabecular Bone in Patients Receiving Antiresorptive Therapy for Osteoporosis and Oncologic Conditions

<b>Objectives</b>: This study aimed to assess the effects of antiresorptive drugs on mandibular trabecular bone structure in patients with osteoporosis and those receiving antiresorptive therapy for oncologic conditions using fractal dimension (FD) analysis of panoramic radiographs. Additionally, it investigated the influences of age, gender, drug type, administration route, and treatment duration on mandibular trabecular bone structure. <b>Methods:</b> This retrospective cross-sectional study included 73 patients categorized into the following three groups: 23 osteoporosis patients, 25 oncologic patients, and 25 systemically healthy controls. FD analysis was conducted on panoramic radiographs to assess trabecular bone complexity in the following three standardized regions of interest: the mandibular condyle, angle, and molar region. Statistical analyses compared the groups and evaluated the associations between FD values and demographic and clinical parameters. <b>Results</b>: Osteoporosis patients exhibited significantly lower FD values in the molar region than controls (<i>p</i> < 0.05). In oncologic patients, the FD values in the condyle region were significantly higher in those receiving denosumab than in those treated with intravenous zoledronic acid (<i>p</i> < 0.05), and in those who had undergone antiresorptive therapy for ≥6 years than in those treated for 1-5 years (<i>p</i> < 0.05). A significant negative correlation was found between age and the FD values of the mandibular angle in osteoporosis patients (<i>p</i> < 0.05); no such association was observed in oncologic patients or controls. <b>Conclusions</b>: Long-term antiresorptive therapy may induce structural alterations in mandibular trabecular bone structure in patients with osteoporosis and oncologic diseases. FD analysis is a non-invasive and objective tool for clinically assessing such drug-induced skeletal changes. However, further large-scale, prospective studies are necessary to confirm these findings and shed light on their clinical significance.