Site-Specific Associations Between CBCT-Derived Gray Value and Fractal Dimension and DEXA T-Scores in Postmenopausal Women: A Cross-Sectional Analytical Study

Objective

Osteoporosis is a silent systemic skeletal disease characterized by microarchitectural deterioration and increased fracture risk; thus, early case-finding is essential. Although dual-energy X-ray absorptiometry (DEXA) is the reference standard for bone mineral density (BMD) assessment, limited accessibility and cost restrict its use for large-scale screening. Given that cone-beam computed tomography (CBCT) is routinely obtained in dental practice, image-derived parameters-gray value (GV) and fractal dimension (FD)-may provide insight into their association with systemic bone mineral density measured by DEXA in postmenopausal women, without additional radiation exposure.