OBJECTIVE: The present study was aimed at comparing indices obtained from dental panoramic radiographs with bone densitometry results in the identification of individuals affected by osteoporosis/osteopenia. MATERIALS AND METHODS: Panoramic mandibular, mental, antegonial, gonial and mandibular cortical indices calculated with basis on dental panoramic radiographs of postmenopausal women were compared with bone densitometry results, twice by one observer and once by a second observer. RESULTS: Significant differences were not found between the two measurements performed by the same observer, except for the antegonial index on the left side. Interobserver agreement for both sides was good. The variance analysis demonstrated statistically significant differences among groups (normal, osteopenia and osteoporosis) for all the indices evaluated. Differences were significant among all mean panoramic mandibular and mental indices. On the other hand, for the antegonial and gonial indices, only the normal group presented higher means as compared with the other groups (osteopenia and osteoporosis) which did not differ between themselves. CONCLUSION: The indices evaluated were reproducible; panoramic mandibular and mental indices presented the highest sensitivity in the detection of osteopenia/osteoporosis, however the panoramic mandibular index specificity was low. Although all the indices evaluated could identify low bone density, only the panoramic mandibular and mental indices could differentiate patients affected by osteopenia/osteoporosis.

Keywords: Osteoporosis, Panoramic radiography, Risk factors

OBJECTIVE: To compare the new normatization of bone densitometry reports on findings at the level of the lumbar spine (L1-L4) proposed by International Society for Clinical Densitometry (ISCD) in 2005, with the classification of World Health Organization (WHO) that was routinely been utilized since 1994. MATERIALS AND METHODS: Bone densitometry studies performed on the lumbar spine of 200 patients at Universidade Católica de Brasília and Hospital das Forças Armadas, Brasília, DF, Brazil, have been evaluated. Inclusion criteria were: female gender, age ranging between 20 and 49 years, and absence of spine morphological changes visualized on the images. The exclusion criteria were: women more than 50 years or menopausal women. RESULTS: Analyzing the bone densitometry reports under the WHO classification, 29 patients were found with osteoporosis, 76 with osteopenia and 95 within normality levels. On the other hand, according to the new ISCD 2005 classification, only 32 patients presented results "below the expected range for age", and 162 "within the expected range for age". CONCLUSION: Significant differences were found when comparing the traditional WHO densitometric classification versus the new one proposed by ISCD 2005. So, this new classification should be known and understood by physicians who request or perform bone densitometry studies, aiming at the correct interpretation, explanation and orientation to the patients.

Keywords: Densitometry, Osteoporosis, Spine, Bone density

Objective: To report the feasibility and safety of percutaneous transluminal angioplasty with paclitaxel-eluting stents for management of vertebral artery stenosis in 14 patients, after two-year follow-up. Materials and Methods: Fourteen patients with a mean age of 67.2 years were submitted to endovascular treatment with placement of paclitaxel-eluting stents. The primary objective of the present study was to evaluate the safety of the procedure. The clinical effectiveness was evaluated according to the rates of restenosis and recurrence of ischemic events. Results: The initial stenosis degree ranged from 50% to 99% (mean, 73.3% ± 10.9%). The rate of technical success achieved 100%. Neither complications directly related to the procedure nor recurrence of symptoms were observed after 24-month follow-up. The rate of intra-stent restenosis was 7.1%, although asymptomatic in all the cases. Conclusion: The present study suggests that vertebral artery angioplasty with paclitaxel-eluting stents is a feasible and promising technique in terms of safety and effectiveness in the prevention of recurrent ischemia and restenosis.

Keywords: Vertebral artery; Angioplasty; Stents.

OBJECTIVE: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. MATERIALS AND METHODS: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1–C2 region. RESULTS: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. CONCLUSION: Inclusion of the C1–C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

Keywords: Craniocerebral trauma; Aged; Aged, 80 and over; Spinal injuries/diagnosis; Cervical vertebrae/injuries; Tomography, X-ray computed.

OBJECTIVE: To promote advanced research using magnetic resonance imaging (MRI) in the diagnosis of and screening for osteoporosis by looking for correlations among the T-scores measured by dual-energy X-ray absorptiometry (DEXA), the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI), and the T1-weighted signal intensity values. MATERIALS AND METHODS: This was a prospective study of postmenopausal women with no contraindications to MRI and no history of cancer who underwent DEXA within 30 days before or after the MRI examination. A 3.0-T scanner was used in order to acquire sagittal sequences targeting the lumbar spine. RESULTS: Thirteen women underwent DEXA and MRI. In two cases, the MRI was discontinued early. Therefore, the final sample comprised 11 patients. The ADC values and T1-weighted signal intensity were found to be higher in patients with osteoporosis. However, among the patients > 60 years of age with osteoporosis, ADC values were lower and T1-weighted signal intensity was even higher. CONCLUSION: It is unlikely that MRI will soon replace DEXA for the diagnostic workup of osteoporosis. Although DWI and ADC mapping are useful for understanding the pathophysiology of osteoporosis, we believe that T1-weighted sequences are more sensitive than is DWI as a means of performing a qualitative analysis of vertebral alterations.

Keywords: Osteoporosis; Postmenopause; Vertebral body/pathology; Multiparametric magnetic resonance imaging/methods; Bone marrow/pathology.

OBJECTIVE: To investigate the relationship between spinopelvic alignment and vertebral fracture in postmenopausal women with osteoporosis.
MATERIALS AND METHODS: This was a retrospective cross-sectional study including 93 women diagnosed with osteopenia or osteoporosis by densitometry between June 2017 and March 2018. Using the software Surgimap to analyze lateral X-rays of the spine and pelvis, we measured the following spinopelvic parameters: pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), global tilt (GT), spinosacral angle (SSA), T1 pelvic angle (TPA), lumbar lordosis (LL), and thoracic kyphosis (TK). The spinopelvic parameters were assessed in relation to fracture occurrence by estimating prevalence ratios. Two groups (patients with and without fractures) were compared on the basis of their spinopelvic parameters. Vertebral fractures were graded by the Genant classification, and the spinal deformity index (SDI) was calculated as the sum of the grades. The SDI was found to correlate with spinopelvic parameters. Intraobserver and interobserver reliability for the measurement of the spinopelvic parameters was evaluated.
RESULTS: The GT correlated significantly with the presence of fractures; the incidence of fracture was found to increase by 2.1% for every 1-degree increase in the GT. The presence of fractures was not found to correlate significantly with the SS, PT, PI, LL, TK, SVA, or SSA. The GT was significantly greater in the group with fractures than in the group without fractures. The SDI correlated significantly with global sagittal balance, as measured by the GT.
CONCLUSION: Fractures seem to be more prevalent among women with a higher GT. The SDI appears to correlate well with global sagittal balance, as assessed by the GT.

Keywords: Spine; Radiography; Spinal fractures; Osteoporosis.