A Logistic Regression Model for Predicting Osteoporosis Using Alveolar Bone Mineral Density Measured on Intraoral Radiographs Combined with Panoramic Mandibular Cortical Index

<b>Background</b>: Osteoporosis screening in dental practice is challenging because dual-energy X-ray absorptiometry is not easily applicable to jaw bones. Objective: This study aimed to evaluate the diagnostic performance of a logistic regression model combining intraoral bone mineral density (BMD) using DentalSCOPE with the panoramic mandibular cortical index (MCI) for osteoporosis screening. <b>Methods</b>: Among 104 patients included in the study, 83 who underwent both intraoral and panoramic radiography were retrospectively selected as a training cohort to develop a logistic regression model for osteoporosis prediction. The mean age was 52.4 years, and 65.1% were female. Intraoral radiographs were analyzed using DentalSCOPE^® (Media Co., Tokyo, Japan) to determine BMD in the alveolar region (al-BMD). On panoramic radiographs, experienced radiologists determined the MCI. An additional 21 patients (mean age 63.1 years; 81.0% female) were prospectively enrolled as an external validation cohort. The trained model was applied to both the training (internal) and external cohorts to evaluate its diagnostic performance, which was compared with that of intraoral or panoramic radiography, using receiver operating characteristic (ROC) analysis. <b>Results</b>: In the training cohort, areas under the ROC curve (AUCs) of al-BMD and MCI were 0.74 and 0.82, respectively, while the combined model showed improved performance with an AUC of 0.88. In the external validation cohort, the AUCs were 0.92 and 0.97 for al-BMD and MCI, respectively. The performance of the combined model improved with an area under the AUC of 1.00. <b>Conclusions</b>: DentalSCOPE-based al-BMD, particularly when combined with panoramic MCI, offers a reliable and practical approach for opportunistic osteoporosis screening in dental care.