Abstract
Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD–L2-IVD–L3 (FSU_L1–L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1–L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1–L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.
Highlights
Osteoporosis is characterized by reduced bone mass and microarchitectural bone deterioration, which can result in fragility fractures [1,2,3]
We investigated whether FEA measurements at the lumbar spine are associated with the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine
This study provides evidence of the relevance of FEA derived from Multi-detector computed tomography (MDCT) for assessment of the biomechanical characteristics of the spine using FSUs
Summary
Osteoporosis is characterized by reduced bone mass and microarchitectural bone deterioration, which can result in fragility fractures [1,2,3]. The T-score derived from DXA-based aBMD is inadequate as the only diagnostic criterion for identifying patients at high fracture risk, which is due to overlaps of DXA-derived aBMD values in patients with and without osteoporotic fractures [12,13]. This shortcoming has driven the emergence of alternative techniques, such as computed tomography (CT) as a widely used modality [14,15,16]. CT data acquired for other purposes than distinct quantitative evaluation of bone health can be used opportunistically to overcome the limitations of DXA by measuring both volumetric BMD (vBMD) and other parameters beyond, which are essential to understand better the multifarious variables of bone quality [14,15,16]
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