Correlation of Fractal Dimensions and Mandibular Cortical Index Assessed Using Panoramic Radiographs in Subjects on Proton Pump Inhibitors Therapy with Serum Biochemical Parameters: A Comparative Cross-Sectional Study

Background Proton pump inhibitors (PPIs) are widely used for upper gastrointestinal conditions. Though blessed with an excellent safety profile, they are being associated with osteoporotic changes and fracture risk. Such bone changes can be reflected in panoramic radiographs (PR) done routinely in dental setups.Objectives The present study aimed to assess, compare, and correlate fractal dimensions (FD) and mandibular cortical index (MCI) of panoramic radiographs with serum calcium, phosphorus, alkaline phosphatase (ALP), and vitamin D in 30 PPI users (study subjects) and 30 age- and gender-matched controls.Materials and Methods Fractal analysis as per White and Rudolph method using Image J and MCI scoring as per the classification of Klemetti et al. (1994) were performed on their panoramic radiographs.Results The fractal dimension of mandibular bone of the study subjects was lesser than that of controls with suggestive statistical significance (p = 0.089). While C1 type of MCI was predominantly seen in both study and control subjects, C2 type was also seen in a sizable number of both groups. A statistically significant (p = 0.016*) decrease in serum calcium was evident in study subjects than in the controls with a positive correlation to FD. MCI showed a positive correlation between serum phosphorus and vitamin D in the study subjects. Lower FD in PPI users suggests they have a less complex bone structure than controls.Conclusions This study highlights the heightened possibility of poor calcium absorption and strengthens the existing concept of induction of osteoporotic effects of PPIs.