FRACTAL DIMENSION AND RADIOMORPHOMETRY OF THE MANDIBLE ON PANORAMIC RADIOGRAPHS AS PREDICTORS OF OSTEOPOROSIS IN TOBACCO USERS: A DXA-BASED PROSPECTIVE CROSS-SECTIONAL STUDY

Introduction: Osteoporosis is a systemic skeletal disorder marked by reduced bone strength and increased fracture risk, often due to alterations in trabecular bone microarchitecture. Tobacco use both smoked and smokeless has emerged as a modifiable risk factor influencing bone health. Panoramic radiography (PR), a common dental imaging modality, offers potential for early detection of osteoporosis through analysis of fractal dimension (FD) and radiomorphometric indices (RMIs). Materials and Methods: This study conducted a comparative evaluation of mandibular bone quality using digital panoramic radiographs and dual-energy X-ray absorptiometry (DXA) scans in tobacco users and non-users aged 20–40 years. Fractal dimension and radiomorphometric parameters including MI, MCI, and PMI were analysed using Image J software. BMD values were obtained using DXA, and statistical analysis was performed to evaluate correlations. Results: Tobacco users demonstrated significantly lower FD values and altered radiomorphometric indices compared to controls, indicating compromised bone quality. A positive correlation was observed between FD/RMIs and DXA-derived BMD values, suggesting their diagnostic utility in early osteoporosis screening. Conclusion: Fractal geometry and radiomorphometric analysis on digital panoramic radiographs may serve as non-invasive, cost-effective indicators of early osteoporotic changes in the mandible, especially in tobacco users. These tools can assist dental practitioners in identifying at-risk individuals for timely medical referral and intervention.