Purpose : The purpose of this study was to investigate whether the fractal dimension and radiographic image brightness of periapical radiograph were useful in predicting osteoporosis. Materials and Methods : Ninety-two postmenopausal women were classified as normal, osteopenia and osteoporosis group according to the bone mineral density of lumbar vertebrae and periapical radiographs of both mandibular molar areas were taken. The ROIs of 358 areas were selected at periapical and interdental areas and fractal dimension and radiographic image brightness were measured. Results : The fractal dimension in normal group was significantly higher than that in osteoporosis group at periapical ROI (P < 0.05). The radiographic image brightness in normal group was higher than that in osteopenia and osteoporosis group. There was significant difference not only between normal and osteopenia group (P < 0.05) but also within osteopenia and osteoporosis group (P< 0.01) at periapical ROI. Significant difference was observed not only between normal and osteopenia group but also between normal and osteoporosis group at interdental ROI (P< 0.01). Positive linear relationship was weakly shown at Pearson correlation analysis between fractal dimension and radiographic image brightness. BMD significantly correlated with fractal dimension at periapical ROI (P< 0.01), and BMD and radiographic image brightness significantly correlated at both periapical and interdental ROIs (P< 0.01). Conclusion : This study suggests that the fractal dimension and radiographic image brightness of periapical ROI may predict BMD. (Korean J Oral Maxillofac Radiol 2005: 35 : 41-6)