EOS biplane radiographs of 117 subjects between 20 and 83 years were analyzed to compute the upper body lever arm over the L1 vertebra and its impact on vertebral strength. Postural sagittal alignment alteration was observed with age and resulted in a greater lever arm causing vertebral strength to decrease.Purpose. The purpose of this study was to analyze the impact of postural alignment changes with age on vertebral strength using finite element analysis and barycentremetry.Methods. A total of 117 subjects from 20 to 83 years were divided in three age groups: young, (20 to 40 years, 62 subjects), intermediate (40 to 60 years, 26 subjects) and elderly (60 years and over, 29 subjects). EOS biplane radiographs were acquired, allowing 3D reconstruction of the spine and body envelope as well as spinal, pelvic and sagittal alignment parameters measurements. A barycentremetry method allowed estimating of the mass and center of mass (CoM) position of the upper body above L1, relatively to the center of the L1 vertebra (lever arm). To investigate the effect of this lever arm, vertebral strength of a generic finite element models (with constant geometry and mechanical properties for all subjects) was successively computed applying the personalized lever arm of each subject. Results.A combination of an increase in thoracic kyphosis, cervical lordosis and pelvic tilt with a loss of lumbar lordosis was observed between the young and the older groups. Sagittal alignment parameters indicated a more forward position as age increased. The lever arm of the CoM above L1 varied from an average of 1 mm backward for the young group, to averages of 7 and 24 mm forward, respectively for the intermediate and elderly group. As a result, vertebral strength decreased from 2527 N for the young group to 1820 N for the elderly group. Conclusion.The global sagittal alignment modifications observed with age were consistent with the literature. Posture alteration with age reduced vertebral strength significantly in this simplified loading model. Postural alignment seems essential to be considered in the evaluation of osteoporotic patients.

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