Research Article
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Evaluation of Cortical and Trabecular Bone Structure of the Mandible in Oral Contraceptive Users

Year 2026, Volume: 29 Issue: 1, 47 - 52, 27.03.2026

Melek Tassoker , Mediha Ertürk

https://doi.org/10.7126/cumudj.1754895
https://izlik.org/JA67NR83DZ

Abstract

Objective: Oral contraceptives (OCs) are widely prescribed hormonal agents that may influence bone homeostasis due to their estrogen content. Estrogen is essential for maintaining skeletal integrity, primarily by modulating osteoblast and osteoclast activity. This study aimed to evaluate whether combined oral contraceptive (COC) use affects mandibular bone microarchitecture using fractal dimension (FD) analysis and panoramic mandibular index (PMI) assessments.
Methods: A case-control design was employed, analyzing digital panoramic radiographs from 290 women aged 18–50, including 145 COC users and 145 age-matched controls. FD values were determined from three mandibular sites: the condyle, angle, and interdental region. PMI values were also computed. Data were analyzed using SPSS software version 21.0 (IBM Corp., Armonk, NY, USA), p<0.05 was considered significant.
Results: There were no statistically significant variations in FD values observed between the COC user group and the control group in the condylar (p=0.183), angular (p=0.603), or interdental (p=0.159) areas. Likewise, there was no significant difference in PMI values between the two groups (p=0.183). Additionally, neither FD nor PMI values were significantly associated with estimated duration of contraceptive use.
Conclusion: Based on FD and PMI measurements, the study found no evidence that COC use leads to notable alterations in mandibular bone structure. These results suggest that estrogen-containing contraceptives may not adversely affect jawbone health in premenopausal women.

Keywords

Oral contraceptives mandibular bone fractal analysis panoramic radiography PMI

References

  • 1. Ampatzis C, Zervoudis S, Iatrakis G, Mastorakos G. Effect of oral contraceptives on bone mineral density. Acta Endocrinol (Buchar) 2022;18:355-360.
  • 2. Almstedt Shoepe H, Snow CM. Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporosis Int 2005;16:1538-1544.
  • 3. Işıklar C, Özçakar N. Long-term health problems in the use of oral contraceptives. TJTFP 2011;2:16-22.
  • 4. Hadji P, Colli E, Regidor PA. Bone health in estrogen-free contraception. Osteoporos Int 2019;30:2391-400.
  • 5. Khosla S, Oursler MJ, Monroe DG. Estrogen and the skeleton. Trends Endocrinol Metab 2012;23:576-581.
  • 6. de Assis ACS, de Oliveira Gamba T, de Moraes MEL, de Moraes LC, Flores IL, de Castro Lopes SLP. Hormone replacement therapy affects mandibular bone architecture in postmenopausal women: a fractal dimension assessment. Rheumatol Orthop Med 2017;1:1-4.
  • 7. Scholes D, Hubbard RA, Ichikawa LE, LaCroix AZ, Spangler L, Beasley JM, et al. Oral contraceptive use and bone density in adolescent and young adult women. Contraception 2010;81:35-40.
  • 8. Nappi C, Bifulco G, Tommaselli GA, Gargano V, Di Carlo C. Hormonal contraception and bone metabolism: a systematic review. Contraception 2012;86:606-21.
  • 9. Güleç M, Taşsöker M, Şener S. Tıpta ve diş hekimliğinde fraktal analiz. EÜ Dişhek Fak Derg 2019;40(1):17-31.
  • 10. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:628-635.
  • 11. Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone mass as measured by a panoramic mandibular index. Oral Surg Oral Med Oral Pathol 1991;71:349-356.
  • 12. Koh KJ, Park HN, Kim KA. Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs. Imaging Sci Dent 2012;42:231-235.
  • 13. Omiotek Z, Dzierzak R, Kepa A. Fractal analysis as a method for feature extraction in detecting osteoporotic bone destruction. Fractals 2021;29:2150095.
  • 14. Ruttimann UE, Webber RL, Hazelrig JB. Fractal dimension from radiographs of peridental alveolar bone. A possible diagnostic indicator of osteoporosis. Oral Surg Oral Med Oral Pathol 1992;74:98-110.
  • 15. Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int 2012;23:1631-1636.
  • 16. Nappi C, Sardo ADS, Greco E, Tommaselli GA, Giordano E, Guida M. Effects of an oral contraceptive containing drospirenone on bone turnover and bone mineral density. Obstetrics & Gynecology 2005;105:53-60.
  • 17. Nappi C, Sardo ADS, Acunzo G, Bifulco G, Tommaselli G, Guida M, Di Carlo C. Effects of a low-dose and ultra-low-dose combined oral contraceptive use on bone turnover and bone mineral density in young fertile women: a prospective controlled randomized study. Contraception 2003;67:355-359.
  • 18. Reed SD, Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM. Longitudinal changes in bone density in relation to oral contraceptive use. Contraception 2003;68:177-182.
  • 19. Gulec M, Erturk M, Tassoker M, Basdemirci M. Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis. Sci Rep 2023;13:19762.
  • 20. Karakus R, Tassoker M, Basdemirci M. Assessment of cortical and trabecular bone structure in the mandible of patients with Behçet's Disease. BMC Oral Health 2025;25(1):323
  • 21. Tasdemir T, Tassoker M. Fractal analysis of mandibular bone structure in children with amelogenesis imperfecta. Bone 2025;199:117571.
  • 22. Sghaireen MG, Alam MK, Patil SR, Rahman SA, Alhabib S, Lynch CD, et al. Morphometric analysis of panoramic mandibular index, mental index, and antegonial index. J Int Med Res 2020;48:0300060520912138.
  • 23. Koseoglu Secgin C, Gulsahi A, Yavuz Y, Kamburoglu K. Comparison of mandibular index values determined from standard panoramic versus cone beam computed tomography reconstructed images. Oral Surg Oral Med Oral Pathol 2019;127:257-264.
  • 24. Gulsahi A, Yüzügüllü B, İmirzalıoğlu P, Genç Y. Assessment of panoramic radiomorphometric indices in Turkish patients of different age groups, gender and dental status. Dentomaxillofac Radiol 2014;37:288-292.
  • 25. Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol 2014;26:95-100.
  • 26. Rupel K, Dal Broi C, Ottaviani G, Bellassai L, Bogdan Preda TM, Di Lenarda R, Biasotto M. Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study. BMC Oral Health 2024;24:89.
  • 27. Herrmann M, Seibel MJ. The effects of hormonal contraceptives on bone turnover markers and bone health. Clin Endocrinol 2010;72:571-583.

Oral Kontraseptif Kullananlarda Mandibulanın Kortikal ve Trabeküler Kemik Yapısının Değerlendirilmesi

Year 2026, Volume: 29 Issue: 1, 47 - 52, 27.03.2026

Melek Tassoker , Mediha Ertürk

https://doi.org/10.7126/cumudj.1754895
https://izlik.org/JA67NR83DZ

Abstract

Amaç: Oral kontraseptifler (OK), östrojen içerikleri nedeniyle kemik metabolizmasını etkileyebilen yaygın olarak kullanılan hormonal ilaçlardır. Östrojen, osteoblast ve osteoklast aktivitesini düzenleyerek kemik yoğunluğunun korunmasında önemli bir rol oynar. Bu çalışma, fraktal analiz ve panoramik mandibular indeks (PMI) ölçümleri kullanarak kombine oral kontraseptiflerin (KOK) mandibular kemik yapısı üzerindeki etkilerini araştırmayı amaçlamıştır.
Yöntem: 18-50 yaş aralığında 290 kadın hastanın (145 COC kullanıcısı ve 145 yaş eşleştirilmiş kontrol) dijital panoramik radyografileri kullanılarak bir vaka-kontrol çalışması yürütülmüştür. Fraktal boyut (FB) değerleri mandibular kondil, angulus ve interdental bölgeden ölçülürken, PMI değerleri hesaplanmıştır. İstatistiksel analiz için SPSS v21.0 (IBM Corp, Armonk, NY, ABD) kullanıldı ve anlamlılık düzeyi p<0,05 olarak belirlenmiştir.
Bulgular: Kondiler (p=0,183), gonial (p=0,603) ve interdental (p=0,159) bölgelerde KOK kullanıcıları ve kontroller arasında FB değerlerinde anlamlı bir fark gözlenmemiştir. Benzer şekilde, PMI değerleri de vaka-kontrol arasında istatistiksel açıdan anlamlı bir ilişki göstermemiştir(p=0,183). Ayrıca, FB ve PMI değerleri KOK kullanım süresiyle anlamlı bir ilişki göstermemiştir.
Sonuç: Bu çalışmada, FB ve PMI ölçümlerine dayanarak, KOK kullanımının mandibular kemik yapısını önemli ölçüde etkilediğine dair bir kanıt bulunamamıştır. Bu bulgular, östrojen içeren kontraseptiflerin menopoz öncesi kadınlarda kemik sağlığını olumsuz etkilemeyebileceğini düşündürmektedir.

Keywords

Oral kontraseptifler mandibular kemik fraktal analiz panoramik radyografi PMI

References

  • 1. Ampatzis C, Zervoudis S, Iatrakis G, Mastorakos G. Effect of oral contraceptives on bone mineral density. Acta Endocrinol (Buchar) 2022;18:355-360.
  • 2. Almstedt Shoepe H, Snow CM. Oral contraceptive use in young women is associated with lower bone mineral density than that of controls. Osteoporosis Int 2005;16:1538-1544.
  • 3. Işıklar C, Özçakar N. Long-term health problems in the use of oral contraceptives. TJTFP 2011;2:16-22.
  • 4. Hadji P, Colli E, Regidor PA. Bone health in estrogen-free contraception. Osteoporos Int 2019;30:2391-400.
  • 5. Khosla S, Oursler MJ, Monroe DG. Estrogen and the skeleton. Trends Endocrinol Metab 2012;23:576-581.
  • 6. de Assis ACS, de Oliveira Gamba T, de Moraes MEL, de Moraes LC, Flores IL, de Castro Lopes SLP. Hormone replacement therapy affects mandibular bone architecture in postmenopausal women: a fractal dimension assessment. Rheumatol Orthop Med 2017;1:1-4.
  • 7. Scholes D, Hubbard RA, Ichikawa LE, LaCroix AZ, Spangler L, Beasley JM, et al. Oral contraceptive use and bone density in adolescent and young adult women. Contraception 2010;81:35-40.
  • 8. Nappi C, Bifulco G, Tommaselli GA, Gargano V, Di Carlo C. Hormonal contraception and bone metabolism: a systematic review. Contraception 2012;86:606-21.
  • 9. Güleç M, Taşsöker M, Şener S. Tıpta ve diş hekimliğinde fraktal analiz. EÜ Dişhek Fak Derg 2019;40(1):17-31.
  • 10. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:628-635.
  • 11. Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone mass as measured by a panoramic mandibular index. Oral Surg Oral Med Oral Pathol 1991;71:349-356.
  • 12. Koh KJ, Park HN, Kim KA. Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs. Imaging Sci Dent 2012;42:231-235.
  • 13. Omiotek Z, Dzierzak R, Kepa A. Fractal analysis as a method for feature extraction in detecting osteoporotic bone destruction. Fractals 2021;29:2150095.
  • 14. Ruttimann UE, Webber RL, Hazelrig JB. Fractal dimension from radiographs of peridental alveolar bone. A possible diagnostic indicator of osteoporosis. Oral Surg Oral Med Oral Pathol 1992;74:98-110.
  • 15. Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int 2012;23:1631-1636.
  • 16. Nappi C, Sardo ADS, Greco E, Tommaselli GA, Giordano E, Guida M. Effects of an oral contraceptive containing drospirenone on bone turnover and bone mineral density. Obstetrics & Gynecology 2005;105:53-60.
  • 17. Nappi C, Sardo ADS, Acunzo G, Bifulco G, Tommaselli G, Guida M, Di Carlo C. Effects of a low-dose and ultra-low-dose combined oral contraceptive use on bone turnover and bone mineral density in young fertile women: a prospective controlled randomized study. Contraception 2003;67:355-359.
  • 18. Reed SD, Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM. Longitudinal changes in bone density in relation to oral contraceptive use. Contraception 2003;68:177-182.
  • 19. Gulec M, Erturk M, Tassoker M, Basdemirci M. Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis. Sci Rep 2023;13:19762.
  • 20. Karakus R, Tassoker M, Basdemirci M. Assessment of cortical and trabecular bone structure in the mandible of patients with Behçet's Disease. BMC Oral Health 2025;25(1):323
  • 21. Tasdemir T, Tassoker M. Fractal analysis of mandibular bone structure in children with amelogenesis imperfecta. Bone 2025;199:117571.
  • 22. Sghaireen MG, Alam MK, Patil SR, Rahman SA, Alhabib S, Lynch CD, et al. Morphometric analysis of panoramic mandibular index, mental index, and antegonial index. J Int Med Res 2020;48:0300060520912138.
  • 23. Koseoglu Secgin C, Gulsahi A, Yavuz Y, Kamburoglu K. Comparison of mandibular index values determined from standard panoramic versus cone beam computed tomography reconstructed images. Oral Surg Oral Med Oral Pathol 2019;127:257-264.
  • 24. Gulsahi A, Yüzügüllü B, İmirzalıoğlu P, Genç Y. Assessment of panoramic radiomorphometric indices in Turkish patients of different age groups, gender and dental status. Dentomaxillofac Radiol 2014;37:288-292.
  • 25. Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol 2014;26:95-100.
  • 26. Rupel K, Dal Broi C, Ottaviani G, Bellassai L, Bogdan Preda TM, Di Lenarda R, Biasotto M. Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study. BMC Oral Health 2024;24:89.
  • 27. Herrmann M, Seibel MJ. The effects of hormonal contraceptives on bone turnover markers and bone health. Clin Endocrinol 2010;72:571-583.
There are 27 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Radiology
Journal Section Research Article
Authors

Melek Tassoker 0000-0003-2062-5713

Mediha Ertürk 0000-0002-8530-9335

Submission Date July 31, 2025
Acceptance Date October 24, 2025
Publication Date March 27, 2026
DOI https://doi.org/10.7126/cumudj.1754895
IZ https://izlik.org/JA67NR83DZ
Published in Issue Year 2026 Volume: 29 Issue: 1

Cite

EndNote Tassoker M, Ertürk M (March 1, 2026) Evaluation of Cortical and Trabecular Bone Structure of the Mandible in Oral Contraceptive Users. Cumhuriyet Dental Journal 29 1 47–52.

Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.


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