Radiomorphometric and texture-based mandibular bone assessment in type 2 diabetes mellitus: correlation with vitamin D, osteocalcin, and glycemic control—an analytical cross-sectional study

This analytical cross-sectional study aimed to evaluate the association between Type 2 diabetes mellitus (T2DM) and mandibular bone quality by integrating biochemical markers with radiomorphometric and texture based indices. A total of four groups were assessed: healthy males, healthy females, diabetic males, and diabetic females. Biochemical parameters were measured, and mandibular bone quality was quantified using Mental Index (MI), Periosteal Indices (PMI-i, PMI-s), Mandibular Cortical Index (MCI), fractal dimension, trabecular strut analysis, and gray-level co-occurrence matrix (GLCM) features. Group differences were analysed using Kruskal-Wallis tests with Dunn's post hoc comparisons, chi-square analysis for categorical variables, Spearman correlations, and multivariable regression models adjusted for age, sex, and glycemic control. Diabetic participants were characterized by significantly lower vitamin D and osteocalcin levels, reduced MI, PMI-i, and PMI-s values, and higher MCI scores, features consistent with cortical thinning and porosity. Fractal dimension and trabecular strut parameters showed a pattern of deterioration predominantly in diabetic males, while texture homogeneity differed between diabetic males and females. Correlation analysis confirmed strong internal consistency among mandibular indices and positive associations with osteocalcin, whereas vitamin D showed limited relationships. Regression models identified diabetes status as an independent correlate of cortical thinning and higher MCI severity, while HbA1c was strongly associated with osteocalcin reduction. T2DM is associated with a clinically meaningful reduction in mandibular cortical and trabecular bone quality, independent of age, sex, and glycemic control. Conventional radiomorphometric indices (MI, PMI, MCI) proved robust, reproducible, and clinically feasible, whereas advanced texture-based parameters showed limited independent explanatory power. Panoramic radiographs may serve as valuable adjunctive tools for opportunistic screening of skeletal alterations co-occuring within diabetic populations, warranting validation through longitudinal studies incorporating DEXA.