Epidemiology of Vertebral Fractures in Women

Melton, L. Joseph; Kan, Stephen H.; Frye, Mark A.; Wahner, Heinz W.; O’Fallon, W. Michael; Riggs, B. Lawrence

doi:10.1093/oxfordjournals.aje.a115204

Cited by 860 publications

(344 citation statements)

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“…Although this is a narrowly focused demographic, our study design is supported by epidemiological data. Specifically, vertebral fractures typically develop between T6 and L3 (6,26), with most frequently fractured sites at T8, T9, and L1 (6). Thus, the thoracic specimens tested in this study -75% of which are between the T8 and T10 levels -are appropriate for investigating clinical fracture strength.…”

Section: Discussionmentioning

confidence: 99%

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Buckley

Loo

Motherway

2007

Bone

141

121

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Patient-specific measures derived from quantitative computed tomography (QCT) scans are currently being developed as a clinical tool for vertebral strength prediction. QCT-based measurement techniques vary greatly in structural complexity and generally fall into one of three categories: 1) bone mineral density (BMD), 2) "mechanics of solids" (MOS) models, such as minimum axial rigidity (the product of axial stiffness and vertebral height), or 3) three dimensional finite element (FE) models. There is no clear consensus as to the relative performance of these measures due to differences in experimental protocols, sample sizes and demographics, and outcome metrics. The goal of this study was to directly compare the performance of QCT-based assessment techniques of varying degrees of structural sophistication in predicting experimental vertebral compressive strength. Eighty-one human thoracic vertebrae (T6 -T10) from 44 donors cadavers (F = 32, M = 12; 85 + 8 y.o., max = 97 y.o., min = 54 y.o.) were QCT scanned and destructively tested in uniaxial compression. The QCT scans were processed to generate FE models and various BMD and MOS measures, including trabecular bone mineral density (tBMD), integral bone mineral density (iBMD), and axial rigidity. Bone mineral density was weakly to moderately predictive of compressive strength (R 2 = 0.16 and 0.62 for tBMD and iBMD, respectively). Ex vivo vertebral strength was strongly correlated with both axial rigidity (R 2 = 0.81) and FE strength measurements (R 2 = 0.80), and the predictive capabilities of these two metrics were statistically equivalent (p > 0.05 for differences between FE and axial rigidity). The results of this study indicate that non-invasive predictive measures of vertebral strength should include some level of structural sophistication, specifically, gross geometric and material property distribution information. However, for uniaxial compression of isolated vertebrae, which is the current biomechanical testing paradigm for new non-invasive strength assessment techniques, QCT-based FE and axial rigidity measures are equivalent predictors of experimental strength. However, before abandoning the FE method in favor of more simplistic techniques, future work should investigate the performance of the FE method versus MOS measures for more physiologically representative loading conditions, e.g., anterior bending or in situ loading with intervertebral discs intact.

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Section: Discussionmentioning

confidence: 99%

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Buckley

Loo

Motherway

2007

Bone

141

121

View full text Add to dashboard Cite

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“…Potential asymptomatic vertebral compression fractures were investigated in all women by standard spinal radiographs in anterior-posterior and lateral positions of the vertebrae Th4-L4. A prevalent fracture was defined, in accordance with previous studies, as at least 20% difference in anterior-posterior, middle-posterior or posterior-posterior adjacent ratio (30,31). Since most patients had a very severe demineralization of the vertebral bodies, it was impossible to use the digitalized technique for vertebral body measurement.…”

Section: Assessment Of Vertebral Fracturesmentioning

confidence: 99%

Effects of sex steroids on bone in women with subclinical or overt endogenous hypercortisolism

et al. 2007

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Objective: Glucocorticoid-induced osteoporosis is the most frequent cause of secondary osteoporosis. Nevertheless, limited data are available on bone status in patients with endogenous cortisol excess. This study is aimed at investigating the role of sex steroids and severity of hypercortisolism on bone mineral density (BMD) and prevalence of vertebral fractures in female patients. Design: Cross-sectional, case-control study. Patients: Seventy-one consecutive women were enrolled: 36 with overt hypercortisolism (26 with ACTH-secreting pituitary adenoma and 10 with cortisol-secreting adrenal tumor) and 35 with subclinical hypercortisolism due to adrenal incidentalomas. They were compared with 71 matched controls. Methods: At diagnosis, we measured serum cortisol, FSH, LH, estradiol, testosterone, androstenedione and DHEAS, and urinary cortisol excretion. BMD was determined by dual energy X-ray absorptiometry at the lumbar spine and femoral neck. Vertebral fractures were investigated by a semiquantitative scoring method. Results: Between women with overt and subclinical hypercortisolism BMD values and prevalence of any vertebral (69 vs 57%, PZ0.56), clinical (28 vs 11.4%, PZ0.22), and multiple vertebral fractures (36 vs 31%, PZ0.92) did not differ. Among patients with subclinical hypercortisolism, amenorrhoic women had a lower BMD (PZ0.035) and more frequent vertebral fractures (80 vs 40%; PZ0.043) when compared with the eumenorrhoic ones. Among women with overt hypercortisolism, there was no difference in lumbar BMD (PZ0.37) and prevalence of fractures (81 vs 60%; PZ0.26) between those amenorrhoic and eumenorrhoic. By logistic regression analysis, lumbar spine BMD values and cortisol-to-DHEAS ratio were the best predictors of vertebral fractures (P!0.01). Conclusions: Vertebral fractures are very common in women with endogenous cortisol excess, regardless of its severity. The deleterious effects of hypercortisolism on the spine may be partly counterbalanced by DHEAS increase at any degree of cortisol excess, and by preserved menstrual cycles in women with subclinical but not in those with overt hypercortisolism.

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“…Percutaneous cement augmentation of vertebral bodies may therefore become more popular in the future, as demographic changes will lead to a dramatic increase in vertebral fractures needing stabilization. The incidence of vertebral fractures for women above the age of 80 may increase above 50% [2]. The increased local stiffness after vertebral augmentation in an otherwise osteoporotic spine bears the risk of a higher incidence of fractures of the adjacent vertebrae and thus prophylactic reinforcement of adjacent vertebrae with a high fracture risk is advisable in certain cases [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage

Benneker

Krebs²,

Boner

et al. 2010

Eur Spine J

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Clinically, the displacement of intravertebral fat into the circulation during vertebroplasty is reported to lead to problems in elderly patients and can represent a serious complication, especially when multiple levels have to be treated. An in vitro study has shown the feasibility of removing intravertebral fat by pulsed jet-lavage prior to vertebroplasty, potentially reducing the embolization of bone marrow fat from the vertebral bodies and alleviating the cardiovascular changes elicited by pulmonary fat embolism. In this in vivo study, percutaneous vertebroplasty using polymethylmethacrylate (PMMA) was performed in three lumbar vertebrae of 11 sheep. In six sheep (lavage group), pulsed jet-lavage was performed prior to injection of PMMA compared to the control group of five sheep receiving only PMMA vertebroplasty. Invasive recording of blood pressures was performed continuously until 60 min after the last injection. Cardiac output and arterial blood gas parameters were measured at selected time points. Post mortem, the injected cement volume was measured using CT and lung biopsies were processed for assessment of intravascular fat. Pulsed jet-lavage was feasible in the in vivo setting. In the control group, the injection of PMMA resulted in pulmonary fat embolism and a sudden and significant increase in mean pulmonary arterial pressure. Pulsed jet-lavage prevented any cardiovascular changes and significantly reduced the severity of bone marrow fat embolization. Even though significantly more cement had been injected into the lavaged vertebral bodies, significantly fewer intravascular fat emboli were identified in the lung tissue. Pulsed jet-lavage prevented the cardiovascular complications after PMMA vertebroplasty in sheep and alleviated the severity of pulmonary fat embolism.

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Epidemiology of Vertebral Fractures in Women

Cited by 860 publications

References 0 publications

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength

Effects of sex steroids on bone in women with subclinical or overt endogenous hypercortisolism

Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage

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