Sickle cell anemia is associated with region-specific alterations in mandibular trabecular bone microarchitecture: a cross-sectional radiographic study

Abstract Background Sickle cell anemia (SCA) is a genetic disorder characterized by altered red blood cell morphology, leading to multiple systemic manifestations, including changes in bone microarchitecture associated with chronic hemolysis, compensatory bone marrow expansion, and altered bone remodeling. This study aimed to characterize mandibular trabecular bone through quantitative panoramic radiographic analysis, comparing patients with SCA and systemically healthy controls across age groups, and to investigate associations with hematological and biochemical markers in patients with SCA. Methods This cross-sectional observational study included 50 patients with SCA and 50 systemically healthy controls matched by age and sex, stratified into two age groups (18–29 and ≥ 30 years). Three mandibular regions of interest (50 × 50 pixels) were analyzed using ImageJ to assess mean pixel intensity, fractal dimension, lacunarity, and trabecular morphometric and connectivity parameters. Statistical analyses included between-group comparisons, two-way analysis of variance, and Spearman correlations, with Benjamini–Hochberg correction for multiple comparisons. Results The median age was 32.5 years, and 68% of participants were female. Patients with SCA aged 18–29 years showed lower mean pixel intensity in the mandibular ramus (ROI1) than controls (mean difference = − 31.16; adjusted p = 0.006). Fractal dimension was also lower in ROI1 among participants aged 18–29 years (adjusted p = 0.033) and ≥ 30 years (adjusted p = 0.014). Lacunarity showed no significant between-group differences after multiple-comparison correction (adjusted p > 0.05), although a group-by-age interaction was observed in the molar region (ROI2; p = 0.011). Among participants aged ≥ 30 years, normalized morphometric parameters were reduced, including the trabecular perimeter-to-total area ratio in ROI1 (adjusted p < 0.001) and ROI3 (adjusted p = 0.007), and the trabecular length-to-trabecular area ratio in ROI1 (adjusted p = 0.019). No associations between radiographic parameters and laboratory markers remained statistically significant after correction (adjusted p ≥ 0.05). Conclusions SCA was associated with radiographic alterations in mandibular trabecular bone, characterized by lower pixel intensity, reduced fractal complexity, and morphometric changes in trabecular extent and organization. Lacunarity showed age-dependent variation without consistent between-group differences. These findings suggest impaired mandibular trabecular bone organization associated with SCA, with patterns varying across anatomical regions and age groups, without confirmed associations with laboratory markers.