# Orthopedic referral rates following osteoporosis screening using dental panoramic radiography in female patients: A three-year prospective study

## TL;DR

This study shows that dental X-rays can help identify osteoporosis in women, but referrals to specialists are low unless dentists provide education.

## Contribution

The study demonstrates that trained oral radiologists significantly increase orthopedic referrals for suspected osteoporosis.

## Key findings

- Only 16.2% of suspected osteoporosis cases were referred to orthopedic care.
- Referral rates were 50.9% higher when oral radiologists provided explanations.
- 60.4% of referred patients were diagnosed with osteoporosis.

## Abstract

Although osteoporosis affects approximately 15.9 million people in Japan, screening rates remain low. Dental panoramic radiographs (DPRs), routinely used in general dental practice, may facilitate opportunistic screening, yet referrals based on these images are not widely implemented. This study evaluated referral rates to orthopedic departments of patients with suspected osteoporosis identified using DPRs.

Among 3237 female patients aged ≥ 50 who underwent DPRs between February 2022 and October 2024, 328 without a prior osteoporosis diagnosis were identified as suspected cases. Their primary dentists referred these patients to our hospital's orthopedic department. Additionally, trained oral radiologists optionally provided information on osteoporosis. We assessed (1) the overall referral rate, (2) differences in referral rates based on whether an explanation by oral radiologist was provided, (3) referral rates stratified by age group, and (4) the prevalence of osteoporosis, osteopenia, and asymptomatic vertebral fractures among referred patients.

Of the 328 patients, 53 (16.2%) visited the orthopedic department. Referral rates were significantly higher among patients who received explanations from trained oral radiologists (50.9%) than among patients who did not (9.1%). Referral rates peaked among patients in their 60s (23.7%). Among referred patients, 60.4% were diagnosed with osteoporosis and 37.7% with osteopenia; five patients had asymptomatic vertebral fractures.

Despite easy access to orthopedic care, referral rates remained low, likely due to limited awareness. Explanations by trained oral radiologists significantly improved referral rates, highlighting the importance of dentist-led education and interdisciplinary collaboration in promoting osteoporosis screening in general dental practice.