Osteoporosis International

, Volume 24, Issue 12, pp 3021–3030 | Cite as

The intravertebral distribution of bone density: correspondence to intervertebral disc health and implications for vertebral strength

  • A. I. HusseinEmail author
  • T. M. Jackman
  • S. R. Morgan
  • G. D. Barest
  • E. F. Morgan
Original Article



This study's goal was to determine associations among the intravertebral heterogeneity in bone density, bone strength, and intervertebral disc (IVD) health. Results indicated that predictions of vertebral strength can benefit from considering the magnitude of the density heterogeneity and the congruence between the spatial distribution of density and IVD health.


This study aims to determine associations among the intravertebral heterogeneity in bone density, bone strength, and IVD health


Regional measurements of bone density were performed throughout 30 L1 vertebral bodies using micro-computed tomography (μCT) and quantitative computed tomography (QCT). The magnitude of the intravertebral heterogeneity in density was defined as the interquartile range and quartile coefficient of variation in regional densities. The spatial distribution of density was quantified using ratios of regional densities representing different anatomical zones (e.g., anterior to posterior regional densities). Cluster analysis was used to identify groups of vertebrae with similar spatial distributions of density. Vertebral strength was measured in compression. IVD health was assessed using two scoring systems.


QCT- and μCT-based measures of the magnitude of the intravertebral heterogeneity in density were strongly correlated with each other (p < 0.005). Accounting for the interquartile range in regional densities improved predictions of vertebral strength as compared to predictions based only on mean density (R 2 = 0.59 vs. 0.43; F-test p-value = 0.018). Specifically, after adjustment for mean density, vertebral bodies with greater heterogeneity in density exhibited higher strength. No single spatial distribution of density was associated with high vertebral strength. Analyses of IVD scores suggested that the health of the adjacent IVDs may modulate the effect of a particular spatial distribution of density on vertebral strength.


Noninvasive measurements of the intravertebral distribution of bone density, in conjunction with assessments of IVD health, can aid in predictions of bone strength and in elucidating biomechanical mechanisms of vertebral fracture.


Computed tomography Heterogeneity Intervertebral disc Strength Vertebra 



Funding was provided by NSF BES 0521255 (EFM), NIH R01 AR054620 (EFM), International Osteoporosis Foundation and Servier Research Group (EFM), and BU/CIMIT Applied Healthcare Fellowship (AIH). The authors also thank Professor Paul Barbone, Dr. Kadin Tseng, Dr. Ginu Unnikrishnan, John Gallagher, Daniel Hogan, Spencer Shore, Alexander Adams, and Gabriel McDonald.

Conflicts of interest



  1. 1.
    Riggs BL, Melton LJ (1986) Involutional osteoporosis. New Engl J Med 314(26):1676–1686CrossRefPubMedGoogle Scholar
  2. 2.
    Van Schoor N, Smit J, Twisk J, Lips P (2005) Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study. Osteoporos Int 16(7):749–756CrossRefPubMedGoogle Scholar
  3. 3.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11(7):556–561CrossRefPubMedGoogle Scholar
  4. 4.
    O'Neill T, Cockerill W, Matthis C, Raspe H, Lunt M, Cooper C, Banzer D, Cannata J, Naves M, Felsch B (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15(9):760–765CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng XG, Nicholson PH, Boonen S, Lowet G, Brys P, Aerssens J, Van der Perre G, Dequeker J (1997) Prediction of vertebral strength in vitro by spinal bone densitometry and calcaneal ultrasound. J Bone Miner Res 12(10):1721–1728CrossRefPubMedGoogle Scholar
  6. 6.
    Kanis JA, Johnell O, Oden A, De Laet C, Jonsson B, Dawson A (2002) Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 30(1):251–258CrossRefPubMedGoogle Scholar
  7. 7.
    Cody DD, Goldstein SA, Flynn MJ, Brown EB (1991) Correlations between vertebral regional bone mineral density (rBMD) and whole bone fracture load. Spine 16(2):146–154PubMedGoogle Scholar
  8. 8.
    Briggs A, Perilli E, Parkinson I, Kantor S, Wrigley T, Fazzalari N, Wark J (2012) Measurement of subregional vertebral bone mineral density in vitro using lateral projection dual-energy X-ray absorptiometry: validation with peripheral quantitative computed tomography. J Bone Miner Metab 30(2):222–231CrossRefPubMedGoogle Scholar
  9. 9.
    Banse X, Devogelaer JP, Munting E, Delloye C, Cornu O, Grynpas M (2001) Inhomogeneity of human vertebral cancellous bone: systematic density and structure patterns inside the vertebral body. Bone 28(5):563–571CrossRefPubMedGoogle Scholar
  10. 10.
    Hussein A, Morgan E (2012) The effect of intravertebral heterogeneity in microstructure on vertebral strength and failure patterns. Osteoporos Int 24(3):979–989CrossRefPubMedGoogle Scholar
  11. 11.
    Yerramshetty J, Kim DG, Yeni YN (2009) Increased microstructural variability is associated with decreased structural strength but with increased measures of structural ductility in human vertebrae. J Biomech Eng 131:094501CrossRefPubMedGoogle Scholar
  12. 12.
    Kim D-G, Hunt C, Zauel R, Fyhrie D, Yeni Y (2007) The effect of regional variations of the trabecular bone properties on the compressive strength of human vertebral bodies. Ann Biomed Eng 35(11):1907–1913CrossRefPubMedGoogle Scholar
  13. 13.
    Wegrzyn J, Roux JP, Arlot ME, Boutroy S, Vilayphiou N, Guyen O, Delmas PD, Chapurlat R, Bouxsein ML (2010) Role of trabecular microarchitecture and its heterogeneity parameters in the mechanical behavior of ex vivo human L3 vertebrae. J Bone Miner Res 25(11):2324–2331CrossRefPubMedGoogle Scholar
  14. 14.
    Keller TS, Hansson TH, Abram AC, Spengler DM, Panjabi MM (1989) Regional variations in the compressive properties of lumbar vertebral trabeculae. Effects of disc degeneration. Spine 14(9):1012–1019CrossRefPubMedGoogle Scholar
  15. 15.
    Keller TS, Ziv I, Moeljanto E, Spengler DM (1993) Interdependence of lumbar disc and subdiscal bone properties: a report of the normal and degenerated spine. J Spinal Disord 6(2):106–113CrossRefPubMedGoogle Scholar
  16. 16.
    Fazzalari NL, Manthey B, Parkinson IH (2001) Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture. Anat Rec 262(3):331–339CrossRefPubMedGoogle Scholar
  17. 17.
    Pollintine P, Dolan P, Tobias JH, Adams MA (2004) Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine 29(7)Google Scholar
  18. 18.
    Homminga J, Aquarius R, Bulsink VE, Jansen CTJ, Verdonschot N (2012) Can vertebral density changes be explained by intervertebral disc degeneration? Med Eng Phys 34(4):453–458CrossRefPubMedGoogle Scholar
  19. 19.
    McNally DS, Adams MA (1992) Internal intervertebral disc mechanics as revealed by stress profilometry. Spine 17(1):66–73CrossRefPubMedGoogle Scholar
  20. 20.
    Adams MA, McNally DS, Dolan P (1996) ‘Stress’ distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br 78(6):965–972CrossRefPubMedGoogle Scholar
  21. 21.
    Kurowski P, Kubo A (1986) The relationship of degeneration of the intervertebral disc to mechanical loading conditions on lumbar vertebrae. Spine 11(7):726–731CrossRefPubMedGoogle Scholar
  22. 22.
    Pollintine P, Dolan P, Tobias JH, Adams MA (2004) Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine (Phila Pa 1976) 29(7):774–782CrossRefGoogle Scholar
  23. 23.
    Pollintine P, Przybyla AS, Dolan P, Adams MA (2004) Neural arch load-bearing in old and degenerated spines. J Biomech 37(2):197–204CrossRefPubMedGoogle Scholar
  24. 24.
    Dai L (1998) The relationship between vertebral body deformity and disc degeneration in lumbar spine of the senile. Eur Spine J 7(1):40–44CrossRefPubMedGoogle Scholar
  25. 25.
    Polikeit A, Nolte LP, Ferguson SJ (2004) Simulated influence of osteoporosis and disc degeneration on the load transfer in a lumbar functional spinal unit. J Biomech 37(7):1061–1069CrossRefPubMedGoogle Scholar
  26. 26.
    Chagnon A, Aubin CE, Villemure I (2010) Biomechanical influence of disc properties on the load transfer of healthy and degenerated discs using a poroelastic finite element model. J Biomech Eng 132(11):111006CrossRefPubMedGoogle Scholar
  27. 27.
    Simpson EK, Parkinson IH, Manthey B, Fazzalari NL (2001) Intervertebral disc disorganization is related to trabecular bone architecture in the lumbar spine. J Bone Miner Res 16(4):681–687CrossRefPubMedGoogle Scholar
  28. 28.
    Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P (2006) Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res 21(9):1409–1416CrossRefPubMedGoogle Scholar
  29. 29.
    Hussein AI, Barbone PE, Morgan EF (2012) Digital volume correlation for study of the mechanics of whole bones. Procedia IUTAM: Symposium on Full-field Measurements and Identification in Solid Mechanics Cachan, France 4-8 July 2011 4:116–125Google Scholar
  30. 30.
    Hong J, Cabe GD, Tedrow JR, Hipp JA, Snyder BD (2004) Failure of trabecular bone with simulated lytic defects can be predicted non-invasively by structural analysis. J Orthop Res 22(3):479–486CrossRefPubMedGoogle Scholar
  31. 31.
    Whealan KM, Kwak SD, Tedrow JR, Inoue K, Snyder BD (2000) Noninvasive imaging predicts failure load of the spine with simulated osteolytic defects. J Bone Joint Surg Am 82(9):1240–1251PubMedGoogle Scholar
  32. 32.
    Kopperdahl DL, Morgan EF, Keaveny TM (2002) Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res 20(4):801–805CrossRefPubMedGoogle Scholar
  33. 33.
    Lane NE, Nevitt MC, Genant HK, Hochberg MC (1993) Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol 20(11):1911–1918PubMedGoogle Scholar
  34. 34.
    Leung VYL, Chan WCW, Hung SC, Cheung KMC, Chan D (2009) Matrix remodeling during intervertebral disc growth and degeneration detected by multichromatic FAST staining. J Histochem Cytochem 57(3):249–256CrossRefPubMedGoogle Scholar
  35. 35.
    Godfrey LG (1998) Tests of non-nested regression models some results on small sample behaviour and the bootstrap. J Econ 84(1):59–74Google Scholar
  36. 36.
    Roux C, Fechtenbaum J, Briot K, Cropet C, Liu-Léage S, Marcelli C (2008) Inverse relationship between vertebral fractures and spine osteoarthritis in postmenopausal women with osteoporosis. Ann Rheum Dis 67(2):224–228CrossRefPubMedGoogle Scholar
  37. 37.
    Sornay-Rendu E, Munoz F, Duboeuf F, Delmas PD (2004) Disc space narrowing is associated with an increased vertebral fracture risk in postmenopausal women: the OFELY study. J Bone Miner Res 19(12):1994–1999CrossRefPubMedGoogle Scholar
  38. 38.
    Sornay-Rendu E, Allard C, Munoz F, Duboeuf F, Delmas PD (2006) Disc space narrowing as a new risk factor for vertebral fracture: the OFELY study. Arthritis Rheum 54(4):1262–1269CrossRefPubMedGoogle Scholar
  39. 39.
    Perilli E, Briggs AM, Kantor S, Codrington J, Wark JD, Parkinson IH, Fazzalari NL (2012) Failure strength of human vertebrae: prediction using bone mineral density measured by DXA and bone volume by micro-CT. Bone 50(6):1416–1425CrossRefPubMedGoogle Scholar
  40. 40.
    McCubbrey DA, Cody DD, Peterson EL, Kuhn JL, Flynn MJ, Goldstein SA (1995) Static and fatigue failure properties of thoracic and lumbar vertebral bodies and their relation to regional density. J Biomech 28(8):891–899CrossRefPubMedGoogle Scholar
  41. 41.
    Nazarian A, Muller R (2004) Time-lapsed microstructural imaging of bone failure behavior. J Biomech 37(1):55–65CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • A. I. Hussein
    • 1
    Email author
  • T. M. Jackman
    • 2
  • S. R. Morgan
    • 1
  • G. D. Barest
    • 3
  • E. F. Morgan
    • 1
  1. 1.Department of Mechanical EngineeringBoston UniversityBostonUSA
  2. 2.Department of Biomedical EngineeringBoston UniversityBostonUSA
  3. 3.Department of RadiologyBoston University School of MedicineBostonUSA

Personalised recommendations