The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture
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We examined how spinal location affects the relationships between quantitative computed tomography (QCT)-based bone measurements and prevalent vertebral fractures. Upper spine (T4–T10) fractures appear to be more strongly related to bone measures than lower spine (T11–L4) fractures, while lower spine measurements are at least as strongly related to fractures as upper spine measurements.
Vertebral fracture (VF), a common injury in older adults, is most prevalent in the mid-thoracic (T7–T8) and thoracolumbar (T12–L1) areas of the spine. However, measurements of bone mineral density (BMD) are typically made in the lumbar spine. It is not clear how the associations between bone measurements and VFs are affected by the spinal locations of both bone measurements and VF.
A community-based case–control study includes 40 cases with moderate or severe prevalent VF and 80 age- and sex-matched controls. Measures of vertebral BMD, strength (estimated by finite element analysis), and factor of risk (load:strength ratio) were determined based on QCT scans at the L3 and T10 vertebrae. Associations were determined between bone measures and prevalent VF occurring at any location, in the upper spine (T4–T10), or in the lower spine (T11–L4).
Prevalent VF at any location was significantly associated with bone measures, with odds ratios (ORs) generally higher for measurements made at L3 (ORs = 1.9–3.9) than at T10 (ORs = 1.5–2.4). Upper spine fracture was associated with these measures at both T10 and L3 (ORs = 1.9–8.2), while lower spine fracture was less strongly associated (ORs = 1.0–2.4) and only reached significance for volumetric BMD measures at L3.
Closer proximity between the locations of bone measures and prevalent VF does not strengthen associations between bone measures and fracture. Furthermore, VF etiology may vary by region, with VFs in the upper spine more strongly related to skeletal fragility.
KeywordsBiomechanics Bone strength Finite element analysis Fracture prediction Osteoporosis
- 4.Kado DM, Huang MH, Karlamangla AS, Cawthon P, Katzman W, Hillier TA, Ensrud K, Cummings SR (2013) Factors associated with kyphosis progression in older women: 15 years’ experience in the study of osteoporotic fractures. J Bone Miner Res 28(1):179–187. doi:10.1002/jbmr.1728 PubMedCentralPubMedCrossRefGoogle Scholar
- 11.Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14(1):61–68PubMedCrossRefGoogle Scholar
- 14.Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporos Int 9(3):206–213PubMedCrossRefGoogle Scholar
- 16.Nevitt MC, Cummings SR, Stone KL, Palermo L, Black DM, Bauer DC, Genant HK, Hochberg MC, Ensrud KE, Hillier TA, Cauley JA (2005) Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res 20(1):131–140PubMedCrossRefGoogle Scholar
- 17.Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18(11):1947–1954. doi:10.1359/jbmr.2003.18.11.1947 PubMedCrossRefGoogle Scholar
- 22.Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25(5):613–619PubMedCrossRefGoogle Scholar
- 23.Melton LJ 3rd, Chao EYS, Lane JM (1988) Biomechanical aspects of fractures. In: Riggs BL, Melton LJ 3rd (eds) Osteoporosis: etiology, diagnosis and management. Raven, New York, pp 111–132Google Scholar
- 27.Samelson EJ, Christiansen BA, Demissie S, Broe KE, Zhou Y, Meng CA, Yu W, Cheng X, O’Donnell CJ, Hoffmann U, Genant HK, Kiel DP, Bouxsein ML (2011) Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study. Osteoporos Int 22(4):1123–1131. doi:10.1007/s00198-010-1290-6 PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Samelson EJ, Christiansen BA, Demissie S, Broe KE, Louie-Gao Q, Cupples LA, Roberts BJ, Manoharam R, D’Agostino J, Lang T, Kiel DP, Bouxsein ML (2012) QCT measures of bone strength at the thoracic and lumbar spine: the Framingham Study. J Bone Miner Res 27(3):654–663. doi:10.1002/jbmr.1482 PubMedCentralPubMedCrossRefGoogle Scholar
- 30.Christiansen BA, Kopperdahl DL, Kiel DP, Keaveny TM, Bouxsein ML (2011) Mechanical contributions of the cortical and trabecular compartments contribute to differences in age-related changes in vertebral body strength in men and women assessed by QCT-based finite element analysis. J Bone Miner Res 26(5):974–983. doi:10.1002/jbmr.287 PubMedCrossRefGoogle Scholar
- 31.Wang X, Sanyal A, Cawthon PM, Palermo L, Jekir M, Christensen J, Ensrud KE, Cummings SR, Orwoll E, Black DM, Keaveny TM (2012) Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res 27(4):808–816. doi:10.1002/jbmr.1539 PubMedCentralPubMedCrossRefGoogle Scholar
- 33.Bouxsein ML, Melton LJ 3rd, Riggs BL, Muller J, Atkinson EJ, Oberg AL, Robb RA, Camp JJ, Rouleau PA, McCollough CH, Khosla S (2006) Age- and sex-specific differences in the factor of risk for vertebral fracture: a population-based study using QCT. J Bone Miner Res 21(9):1475–1482PubMedCrossRefGoogle Scholar
- 36.Oudshoorn C, Hartholt KA, Zillikens MC, Panneman MJ, van der Velde N, Colin EM, Patka P, van der Cammen TJ (2012) Emergency department visits due to vertebral fractures in the Netherlands, 1986–2008: steep increase in the oldest old, strong association with falls. Injury 43(4):458–461. doi:10.1016/j.injury.2011.09.014 PubMedCrossRefGoogle Scholar
- 41.Riggs BL, Melton LJ 3rd, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, Rouleau PA, McCollough CH, Bouxsein ML, Khosla S (2004) Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res 19(12):1945–1954. doi:10.1359/JBMR.040916 PubMedCrossRefGoogle Scholar