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01-02-2014 | Original Article

The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture

Authors: D. E. Anderson, S. Demissie, B. T. Allaire, A. G. Bruno, D. L. Kopperdahl, T. M. Keaveny, D. P. Kiel, M. L. Bouxsein

Published in: Osteoporosis International | Issue 2/2014

Abstract

Summary

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.

Introduction

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.

Methods

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).

Results

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.

Conclusions

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.

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475. doi:10.1359/jbmr.061113 PubMedCrossRef

Melton LJ 3rd, Kan SH, Frye MA, Wahner HW, O’Fallon WM, Riggs BL (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129(5):1000–1011PubMed

Melton LJ 3rd, Lane AW, Cooper C, Eastell R, O’Fallon WM, Riggs BL (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3(3):113–119PubMedCrossRef

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 PubMedCentralPubMedCrossRef

Lombardi I Jr, Oliveira LM, Mayer AF, Jardim JR, Natour J (2005) Evaluation of pulmonary function and quality of life in women with osteoporosis. Osteoporos Int 16(10):1247–1253. doi:10.1007/s00198-005-1834-3 PubMedCrossRef

Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8(3):261–267PubMedCrossRef

Hasserius R, Karlsson MK, Jonsson B, Redlund-Johnell I, Johnell O (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly—a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76:235–242PubMedCrossRef

Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128(10):793–800PubMedCrossRef

Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15(8):1564–1572. doi:10.1359/jbmr.2000.15.8.1564 PubMedCrossRef

10.

Salaffi F, Cimmino MA, Malavolta N, Carotti M, Di Matteo L, Scendoni P, Grassi W (2007) The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol 34(7):1551–1560PubMed

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):61–68PubMedCrossRef

12.

Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, Cummings SR (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 14:589–594PubMedCrossRef

13.

Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20(4):557–563. doi:10.1359/JBMR.041214 PubMedCrossRef

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):206–213PubMedCrossRef

15.

Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA (2002) The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 17(6):1051–1056. doi:10.1359/jbmr.2002.17.6.1051 PubMedCrossRef

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):131–140PubMedCrossRef

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 PubMedCrossRef

18.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739PubMedCrossRef

19.

Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323PubMedCrossRef

20.

Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34(1):195–202PubMedCrossRef

21.

Schuit S, van der Klift M, Weel A, De Laet C, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen J, Pols H (2006) Corridendum to "Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study". Bone 38:603CrossRef

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):613–619PubMedCrossRef

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 111–132

24.

Cooper C, O’Neill T, Silman A (1993) The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone 14(Suppl 1):S89–97PubMedCrossRef

25.

Hoffmann U, Massaro JM, Fox CS, Manders E, O’Donnell CJ (2008) Defining normal distributions of coronary artery calcium in women and men (from the Framingham Heart Study). Am J Cardiol 102(9):1136–1141. doi:10.1016/j.amjcard.2008.06.038 PubMedCentralPubMedCrossRef

26.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148. doi:10.1002/jbmr.5650080915 PubMedCrossRef

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 PubMedCentralPubMedCrossRef

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 PubMedCentralPubMedCrossRef

29.

Lang TF, Li J, Harris ST, Genant HK (1999) Assessment of vertebral bone mineral density using volumetric quantitative CT. J Comput Assist Tomogr 23(1):130–137PubMedCrossRef

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 PubMedCrossRef

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 PubMedCentralPubMedCrossRef

32.

Crawford RP, Cann CE, Keaveny TM (2003) Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33(4):744–750PubMedCrossRef

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):1475–1482PubMedCrossRef

34.

Iyer S, Christiansen BA, Roberts BJ, Valentine MJ, Manoharan RK, Bouxsein ML (2010) A biomechanical model for estimating loads on thoracic and lumbar vertebrae. Clin Biomech (Bristol, Avon) 25(9):853–858. doi:10.1016/j.clinbiomech.2010.06.010 CrossRef

35.

Leucht P, Fischer K, Muhr G, Mueller EJ (2009) Epidemiology of traumatic spine fractures. Injury 40(2):166–172. doi:10.1016/j.injury.2008.06.040 PubMedCrossRef

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 PubMedCrossRef

37.

Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7(2):221–227PubMedCrossRef

38.

Freitas SS, Barrett-Connor E, Ensrud KE, Fink HA, Bauer DC, Cawthon PM, Lambert LC, Orwoll ES (2008) Rate and circumstances of clinical vertebral fractures in older men. Osteoporos Int 19(5):615–623. doi:10.1007/s00198-007-0510-1 PubMedCrossRef

39.

Edmondston SJ, Singer KP, Day RE, Price RI, Breidahl PD (1997) Ex vivo estimation of thoracolumbar vertebral body compressive strength: the relative contributions of bone densitometry and vertebral morphometry. Osteoporos Int 7(2):142–148PubMedCrossRef

40.

Ruyssen-Witrand A, Gossec L, Kolta S, Dougados M, Roux C (2007) Vertebral dimensions as risk factor of vertebral fracture in osteoporotic patients: a systematic literature review. Osteoporos Int 18(9):1271–1278. doi:10.1007/s00198-007-0356-6 PubMedCrossRef

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 PubMedCrossRef

42.

Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33(4):522–532PubMedCrossRef

43.

Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18(12):1617–1624. doi:10.1007/s00198-007-0413-1 PubMedCrossRef

Title: The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture
Authors: D. E. Anderson
S. Demissie
B. T. Allaire
A. G. Bruno
D. L. Kopperdahl
T. M. Keaveny
D. P. Kiel
M. L. Bouxsein
Publication date: 01-02-2014
Publisher: Springer London
Published in: Osteoporosis International / Issue 2/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-013-2452-0

At a glance: The STEP trials

Springer Medicine

The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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