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Biomechanics of Vertebral Fractures and the Vertebral Fracture Cascade

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Abstract

Vertebral fractures (VFxs) are the most common osteoporotic fracture, and are a strong risk factor for future fracture. The presence of a VFx greatly increases the risk of sustaining subsequent VFxs—a phenomenon often referred to as the “vertebral fracture cascade.” VFxs do not occur uniformly along the spine, but occur more often at the mid-thoracic and thoracolumbar regions than elsewhere. It is likely that both the vertebral fracture cascade and the bimodal distribution of VFx along the spine are attributable to biomechanical factors. VFxs occur when the forces applied to the vertebral body exceed its strength. Loading on the spine is primarily determined by a person’s height, weight, muscle forces, and the task or movement performed, but can also be affected by other factors, such as spinal curvature and invertebral disk deterioration. Vertebral strength is determined mainly by bone size, shape, and bone mineral density, and secondarily by bone microarchitecture, collagen characteristics, and microdamage. Better understanding of VFx etiology is hampered by the fact that most VFxs do not come to clinical attention; therefore, the factors and activities that cause VFxs remain ill defined, including possible differences in the etiology of acute fractures versus those of slow onset. Additional research is needed to elucidate the precise mechanical, morphologic, and biological mechanisms that underlie VFx to improve strategies for assessing VFx risk and preventing the vertebral fracture cascade.

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Acknowledgments

This work was supported by NIH grants R01AR053986 and T32 AG023480.

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Orthopaedics, UC Davis Medical Center, 4635 Second Avenue, Room 2002, Sacramento, CA, 95817, USA

    Blaine A. Christiansen

  2. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopaedic Surgery, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Mary L. Bouxsein

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  1. Blaine A. Christiansen
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Correspondence to Mary L. Bouxsein.

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Christiansen, B.A., Bouxsein, M.L. Biomechanics of Vertebral Fractures and the Vertebral Fracture Cascade. Curr Osteoporos Rep 8, 198–204 (2010). https://doi.org/10.1007/s11914-010-0031-2

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