Normal vertebral body size and compressive strength: Relations to age and to vertebral and iliac trabecular bone compressive strength

Mosekilde, Li.

doi:10.1016/8756-3282(86)90019-0

Cited by 216 publications

(80 citation statements)

References 22 publications

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“…These results suggest that the size of the vertebral body influences the type of vertebral body deformity. Our findings support numerous reports that the compressive strength of the vertebra is determined not only by bone density, (Atkinson, 1967;Rockoff et al, 1969;Mosekilde and Mosekilde, 1986;Brinckman et al, 1989) but also by cross-sectional area (Brinckman et al, 1989;Gilsanz et al, 1995). Many of these reports, however, are for in vitro studies and the results are not easily translated to the in vivo situation.…”

Section: Discussionsupporting

confidence: 81%

“…Remodelling in long bones results in an increased outer cortical diameter, and so it is possible that similar modelling effects occur in vertebral bodies to increase the axial area (Smith and Walker, 1964). The increased axial area could aid in spreading the applied spinal forces through the disc, over a greater axial area, thus reducing the force per unit area on the vertebral bone (Mosekilde and Mosekilde, 1986). Increased vertebral axial area, however, will contribute to an increase of vertebral body volume with no change in bone mass.…”

Section: Discussionmentioning

confidence: 99%

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Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture

2001

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Vertebral deformity, intervertebral disc disorganisation, and change to vertebral bone architecture are morphological features that are associated with low back pain. The purpose of this study was to examine the influence of the morphological disorganisation of the intervertebral disc on vertebral body shape indices and vertebral cancellous bone architecture. Lumbar spines, T12-S1, were collected from 27 cadavers. The motion segments T12-L1, L2-L3 and L4 -L5 were selected for the study. There were 8 females aged 35-94 years and 19 males aged 20 -90 years. An intervertebral disc grade signifying the severity of disc disorganisation was assigned to each disc using the macroscopic disc grading criteria of Hansson and Roos (Spine, 1981; 6:147-153.). Vertebral shape indices and vertebral body bone histomorphometric analyses were performed on the vertebral bodies. Where appropriate, data were age adjusted and the influence of morphological disc disorganisation on vertebral body deformity and cancellous bone architecture analysed. Increased vertebral body axial area and the ratio of vertebral body axial area to sagittal area were associated with an increase in vertebral deformity and disc disorganisation. This suggests that vertebral deformity that remains clinically silent in the general population is influenced by intervertebral disc disorganisation. Vertebral cancellous bone architecture undergoes change associated with increased disc disorganisation, consistent with increased vertebral deformity. Vertebral bodies adjacent to degenerate discs (Grade 4) showed increased BV/TV and Tb.Th and decreased BS/BV. This shows that disc disorganisation may modulate vertebral cancellous bone architecture such that it protects against age-related bone changes. In addition, vertebral body wedging and concavity are associated with smaller vertebral body size and vertebral body compression is associated with larger vertebral body size and compromised cancellous bone architecture. Anat Rec 262: [331][332][333][334][335][336][337][338][339] 2001. © 2001 Wiley-Liss, Inc.Key words: disc disorganisation; vertebral shape indices; cancellous bone; disc grade; osteoporosisThe aetiology of low back pain due to osteoarthritis, osteoporotic vertebral crush fracture, and the effect of ageing is poorly understood. Vertebral deformity, intervertebral disc disorganisation, and change to vertebral bone architecture are morphological features that are associated with low back pain. Study of the relationships between these phenomena will help to elucidate the factors that are associated with clinical symptoms.Changes in vertebral body shape are not necessarily the result of osteoporotic collapse (Kleerekoper et al., 1992a,b;Evans et al., 1993). The shape of the vertebral body may be influenced by many factors. Mild or even moderate vertebral deformity may arise from lifelong age-related changes in vertebral bone architecture (Hansson and

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture

2001

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“…However validation of the trabecular core model and initial comparisons with the literature indicate the predictions of the vertebra model are reasonable. Reported vertebral body compressive strengths range from approximately 60MPa for a 20 year old vertebra to 2.6MPa for an 80 year old vertebra [13]. The predicted compressive strengths for the vertebral models of different ages are comparable with these values, although slightly lower.…”

Section: A Trabecular Coresupporting

confidence: 67%

Relative Roles of Cortical and Trabecular Thinning in Reducing Osteoporotic Vertebral Body Stiffness: A Modeling Study

et al. 2009

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Abstract-While the effects of reduced bone density on osteoporotic vertebral strength are well known, the relative roles of cortical shell and trabecular architecture thinning in determining vertebral stiffness and strength are less clear. These are important parameters in investigating the changing biomechanics of the ageing spine, and in assessing the effect of stiffening procedures such as vertebroplasty on neighbouring spinal segments. This work presents the development of a microstructural computer model of the osteoporotic lumbar vertebral body, allowing detailed prediction of the effects of bone micro-architecture on vertebral stiffness and strength.Microstructural finite element models of an L3 human vertebral body were created. The cortex geometry was represented with shell elements and the trabecular network with a lattice of beam elements. Trabecular architecture was varied according to age. Each beam network model was validated against experimental data. Models were generated to represent vertebral bodies of age <50 years, age 50-75y and age >75y respectively. For all models, an initial cortical shell thickness of 0.5mm was used, followed by reductions in the age >75y models to 0.35mm and 0.2mm to represent cortical thinning in late stage osteoporosis. Loads were applied to simulate in vitro biomechanical testing, compressing the vertebra by 20% of its height.Predicted vertebral stiffness and strength reduced with progressive age changes in microarchitecture, demonstrating a 44% reduction in stiffness and a 43% reduction in strength, between the age <50 and age >75 models. Reducing cortical thickness in the age >75 models demonstrated a substantial reduction in stiffness and strength, resulting in a 48% reduction in stiffness and a 62% reduction in strength between the 0.5mm and 0.2mm cortical thickness models. Cortical thinning in late stage osteoporosis may therefore play an even greater role in reducing vertebral stiffness and strength than earlier reductions due to trabecular thinning.

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“…(24)(25)(26) In contrast, agerelated decreases in strength increase the risk of fracture by moving the bone closer to or below its fracture threshold. Mosekilde et al (27,28) estimated that ∼10% of vertebral strength is lost per decade, and this loss is exacerbated further in individuals with osteoporosis. Considering treatment with alendronate is known to decrease vertebral fracture incidence by about 50% at 12 months in postmenopausal women having osteoporosis, (29) the results of this analysis suggest that even modest treatment-induced increases in vertebral strength, such as those observed for a majority of alendronate-treated patients in this study, may prevent osteoporotic vertebral fractures by primarily halting age-and osteoporosis-related declines in vertebral strength.…”

Section: Discussionmentioning

confidence: 99%

Effects of Teriparatide and Alendronate on Vertebral Strength as Assessed by Finite Element Modeling of QCT Scans in Women With Osteoporosis

Keaveny

Donley

Hoffmann

et al. 2007

Journal of Bone and Mineral Research

234

137

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FE modeling was used to estimate the biomechanical effects of teriparatide and alendronate on lumbar vertebrae. Both treatments enhanced predicted vertebral strength by increasing average density. This effect was more pronounced for teriparatide, which further increased predicted vertebral strength by altering the distribution of density within the vertebra, preferentially increasing the strength of the trabecular compartment.Introduction: Teriparatide 20 g/day (TPTD) and alendronate 10 mg/day (ALN) increase areal, measured by DXA, and volumetric, measured by QCT, lumbar spine BMD through opposite effects on bone remodeling. Using finite element (FE) modeling of QCT scans, we sought to compare the vertebral strength characteristics in TPTD-and ALN-treated patients. Materials and Methods: A subset of patients (N ‫ס‬ 28 TPTD; N ‫ס‬ 25 ALN) from the Forteo Alendronate Comparator Trial who had QCT scans of the spine at baseline and postbaseline were analyzed. The QCT scans were analyzed for compressive strength of the L 3 vertebra using FE modeling. In addition, using controlled parameter studies of the FE models, the effects of changes in density, density distribution, and geometry on strength were calculated, a strength:density ratio was determined, and a response to bending was also quantified. Results: Both treatments had positive effects on predicted vertebral strength characteristics. At least 75% of the patients in each treatment group had increased strength of the vertebra at 6 months compared with baseline. Patients in both treatment groups had increased average volumetric density and increased strength in the trabecular bone, but the median percentage increases for these parameters were 5-to 12-fold greater for TPTD. Larger increases in the strength:density ratio were also observed for TPTD, and these were primarily attributed to preferential increases in trabecular strength. Conclusions: These results provide new insight into the effects of these treatments on estimated biomechanical properties of the vertebra. Both treatments positively affected predicted vertebral strength through their effects on average BMD, but the magnitudes of the effects were quite different. Teriparatide also affected vertebral strength by altering the distribution of density within the vertebra, so that overall, teriparatide had a 5-fold greater percentage increase in the strength:density ratio.

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Normal vertebral body size and compressive strength: Relations to age and to vertebral and iliac trabecular bone compressive strength

Cited by 216 publications

References 22 publications

Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture

Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture

Relative Roles of Cortical and Trabecular Thinning in Reducing Osteoporotic Vertebral Body Stiffness: A Modeling Study

Effects of Teriparatide and Alendronate on Vertebral Strength as Assessed by Finite Element Modeling of QCT Scans in Women With Osteoporosis

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