Mandibular Trabecular Bone Microarchitecture in Statin-Treated Versus Statin-Naive Hyperlipidemic Patients

CONTEXT: This retrospective investigation compared mandibular trabecular architecture on panoramic radiographs between hyperlipidemic adults who had used atorvastatin for at least 12 months and age- and sex-matched hyperlipidemic adults with no previous statin treatment. Trabecular complexity was assessed using fractal dimension (FD) analysis. SETTINGS AND DESIGN: A total of 240 hyperlipidemic participants were included, comprising 120 individuals treated with atorvastatin for at least 1 year and 120 age- and sex-matched participants with no previous statin use. MATERIALS AND METHODS: FD measurements were obtained with ImageJ using the box-counting approach in four mandibular regions: the condyle, angulus, posterior mandible, and anterior mandible. STATISTICAL ANALYSIS USED: Between-group and related comparisons were examined with the Mann-Whitney U and Wilcoxon tests, and associations were assessed by Spearman correlation. The significance threshold was P < 0.05, and the four predefined regional group comparisons were adjusted with the Bonferroni method. RESULTS: Mean FD values were numerically higher in the atorvastatin-treated group across all evaluated regions. However, after Bonferroni correction, only the difference in the mandibular angle remained statistically significant ( P = 0.011; adjusted P = 0.044). A moderate positive correlation was identified between the mandibular angle and condyle ( r = 0.449, P < 0.001). Interobserver agreement was high (ICC range, 0.803-0.906). CONCLUSION: Although FD values tended to be higher among participants receiving atorvastatin therapy, statistical significance was confined to the mandibular angle, where the absolute difference was small. Therefore, long-term atorvastatin use may be associated with a subtle, site-specific radiographic variation in mandibular trabecular architecture among individuals with hyperlipidemia.