Panoramic Images Evidencing Calcified Carotid Atheromas Herald Femoral Neck Osteopenia

Objectives:    Osteopenia or “low bone mineral density” (BMD) of the femoral neck predisposes individuals to increased risk of low-trauma/fragility hip fracture. White women are almost three times more likely to sustain such a fracture than Black Women because of differences in rate of bone loss after menopause and bone size. About 1 in 4 individuals with hip fracture requires nursing home care and within 1 year of that incident approximately 20% of them die. Low BMD is often under diagnosed until fragility fractures occur because preclinical symptoms remain ill defined. Bone mineralization inhibition is likely controlled by proteins which also foster vascular calcification. Therefore, we evaluated the relationship between calcified carotid artery plaque (CCAP) on panoramic images and BMD (mean T-score) on Dual energy X-ray Absorptiometry (DXA) bone scans.

Methods:   Images and hospital records identified by dentists defined two study groups (20 White women and 24 Black women) having CCAP and incidentally obtained bone scans.  Ethnically matched (age ±7 years, BMI ± 3 units) control groups with panoramic images devoid of CCAP but having accompanying DXA scans were likewise constituted.  A physician determined the BMD (mean T-score) on the DXA.

Results: Femoral neck BMD  was significantly lower (p=0.009) for White women as a group, irrespective of CCAP status, when compared to Black women. Women with CCAP had significant (p=0.029) poorer femoral neck BMD compared to those without CCAP irrespective of ethnicity. White CCAP+ women had significantly lower femoral neck BMD than White CCAP- women (p=0.05). This finding did not hold true for Blacks (p=0.1). The presence or absence of CCAP did not affect BMD in the L₁-L₄ and “total hip” regions in either ethnic group. 

Conclusions:   We observed a significant inverse association between the CCAP on panoramic images and femoral neck BMD (mean T-score) in postmenopausal White women.