Prediction of thoracic and lumbar vertebral body compressive strength: correlations with bone mineral density and vertebral region

Singer, Kevin; Edmondston, Stephen J.; Day, Robert E.; Breidahl, P. D.; Price, Roger I.

doi:10.1016/s8756-3282(95)00165-4

Cited by 161 publications

(109 citation statements)

References 26 publications

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“…There is an increase in the cross-sectional area of vertebrae from the upper thoracic to the lower lumbar spine level, which reflects an adaptation to the loadbearing requirements of the spine. An ex vivo study showed that, besides the increase of vertebral crosssectional area, the density of cancellous bone measured by quantitative computed tomography decreased progressively, whereas areal measures of BMD and failure loads increased progressively (51). DSN is more frequently seen in the lowest part of the lumbar spine, where the gravity loading of the spine is greater.…”

Section: Discussionmentioning

confidence: 99%

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Sornay‐Rendu

Allard

Munoz

et al. 2006

Arthritis & Rheumatism

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Objective. In a previous cross-sectional analysis, we found a positive association between disc space narrowing (DSN) and vertebral fracture. The aim of the present study was to analyze prospectively the risk of vertebral and nonvertebral fractures in women with spine osteoarthritis (OA).Methods. Using radiographs, spine OA was evaluated in 634 postmenopausal women from the OFELY (Os des Femmes de Lyon) cohort (mean ؎ SD age 61.2 ؎ 9 years). Prevalence and severity of spine OA were assessed by scoring osteophytes and DSN. Incidental clinical fractures were prospectively registered during annual followup, and vertebral fractures were evaluated by radiography every 4 years.Results. During an 11-year followup, fractures occurred in 121 women, including 42 with vertebral fractures. No association was found between osteophytes and the risk of fracture. In contrast, DSN was associated with an increased risk of vertebral fractures but not of nonvertebral fractures. After adjusting for confounding variables, the presence of DSN was associated with a marked increased risk of vertebral fractures, with an odds ratio of 6.59 (95% confidence interval 1.36-31.9). In addition, 95% of incident vertebral fractures were located above the disc with the most severe narrowing.Conclusion. This longitudinal study shows that, despite a higher bone mineral density (BMD), women with spine OA do not have a reduced risk of fracture and that DSN is significantly associated with vertebral fracture risk. The location of DSN and of incident vertebral fractures suggests that disc degeneration impairs the biomechanics of the above spine, which leads to the increased risk of vertebral fractures, independent of BMD. We suggest that DSN is a newly identified risk factor for vertebral fracture that should be taken into consideration when assessing vertebral fracture risk in postmenopausal women.

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Section: Discussionmentioning

confidence: 99%

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Sornay‐Rendu

Allard

Munoz

et al. 2006

Arthritis & Rheumatism

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“…There have been numerous experimental studies of the ability of BMD and MOS to predict vertebral strength (2,5,(12)(13)(14)17,18,25,27,28,33,35); however, there is no clear consensus as to the relative performance of these measures. This may be due to inter-study differences in sample sizes (N = 11 (27) to N = 378 (24)), testing protocols (isolated vertebral bodies versus functional spinal units), and outcome measures (ultimate axial force versus ultimate axial stress) ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

“…In general, there is evidence that DXA-BMD is a moderately good predictor of experimental vertebral strength, with R 2 values in the range 0.46 -0.83 (see Table 1). QCT trabecular bone mineral density (tBMD) is a somewhat weaker predictor (R 2 = 0.08 -0.67, see Table 1), but correlations with experimental strength improve if tBMD is normalized by minimum transverse plane cross sectional area (A min ) (5,14,33).…”

Section: Introductionmentioning

confidence: 99%

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Buckley

Loo

Motherway

2007

Bone

142

121

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Patient-specific measures derived from quantitative computed tomography (QCT) scans are currently being developed as a clinical tool for vertebral strength prediction. QCT-based measurement techniques vary greatly in structural complexity and generally fall into one of three categories: 1) bone mineral density (BMD), 2) "mechanics of solids" (MOS) models, such as minimum axial rigidity (the product of axial stiffness and vertebral height), or 3) three dimensional finite element (FE) models. There is no clear consensus as to the relative performance of these measures due to differences in experimental protocols, sample sizes and demographics, and outcome metrics. The goal of this study was to directly compare the performance of QCT-based assessment techniques of varying degrees of structural sophistication in predicting experimental vertebral compressive strength. Eighty-one human thoracic vertebrae (T6 -T10) from 44 donors cadavers (F = 32, M = 12; 85 + 8 y.o., max = 97 y.o., min = 54 y.o.) were QCT scanned and destructively tested in uniaxial compression. The QCT scans were processed to generate FE models and various BMD and MOS measures, including trabecular bone mineral density (tBMD), integral bone mineral density (iBMD), and axial rigidity. Bone mineral density was weakly to moderately predictive of compressive strength (R 2 = 0.16 and 0.62 for tBMD and iBMD, respectively). Ex vivo vertebral strength was strongly correlated with both axial rigidity (R 2 = 0.81) and FE strength measurements (R 2 = 0.80), and the predictive capabilities of these two metrics were statistically equivalent (p > 0.05 for differences between FE and axial rigidity). The results of this study indicate that non-invasive predictive measures of vertebral strength should include some level of structural sophistication, specifically, gross geometric and material property distribution information. However, for uniaxial compression of isolated vertebrae, which is the current biomechanical testing paradigm for new non-invasive strength assessment techniques, QCT-based FE and axial rigidity measures are equivalent predictors of experimental strength. However, before abandoning the FE method in favor of more simplistic techniques, future work should investigate the performance of the FE method versus MOS measures for more physiologically representative loading conditions, e.g., anterior bending or in situ loading with intervertebral discs intact.

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“…Although bone mineral density (BMD) accounts for a large proportion of the variance observed in vertebral bone strength in the thoracic and lumbar spine [43], areal BMD still remains an inadequate predictor of vertebral fracture risk. The strong relationship between BMD and bone strength underlines the rationale for the use of densitometry in assessing fracture risk and skeletal status.…”

Section: Introductionmentioning

confidence: 99%

Paraspinal muscle control in people with osteoporotic vertebral fracture

et al. 2007

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The high risk of sustaining subsequent vertebral fractures after an initial fracture cannot be explained solely by low bone mass. Extra-osseous factors, such as neuromuscular characteristics may help to explain this clinical dilemma. Elderly women with (n = 11) and without (n = 14) osteoporotic vertebral fractures performed rapid shoulder flexion to perturb the trunk while standing on a flat and short base. Neuromuscular postural responses of the paraspinal muscles at T6 and T12, and deep lumbar multifidus at L4 were recorded using intramuscular electromyography (EMG). Both groups demonstrated bursts of EMG that were initiated either before or shortly after the onset of shoulder flexion (P < 0.05). Paraspinal and multifidus onset occurred earlier in the non-fracture group (50-0 ms before deltoid onset) compared to the fracture group (25 ms before and 25 ms after deltoid onset) in the flat base condition. In the short base condition, EMG amplitude increased significantly above baseline earlier in the non-fracture group (75-25 ms before deltoid onset) compared to the fracture group (25-0 ms before deltoid onset) at T6 and T12; yet multifidus EMG increased above baseline earlier in the fracture group (50-25 ms before deltoid) compared to the non-fracture group (25-0 ms before deltoid). Time to reach maximum amplitude was shorter in the fracture group. Hypothetically, the longer time to initiate a postural response and shorter time to reach maximum amplitude in the fracture group may indicate a neuromuscular contribution towards subsequent fracture aetiology. This response could also be an adaptive characteristic of the central nervous system to minimise vertebral loading time.

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Prediction of thoracic and lumbar vertebral body compressive strength: correlations with bone mineral density and vertebral region

Cited by 161 publications

References 26 publications

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Paraspinal muscle control in people with osteoporotic vertebral fracture

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