Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures.

Gilsanz, Vicente; Loro, M L; Roe, Thomas; Sayre, James W.; Gilsanz, R; Schulz, Eloy

doi:10.1172/jci117925

Cited by 149 publications

(74 citation statements)

References 29 publications

(38 reference statements)

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“…Thus, results of the present study agree with previous reports that suggest a feed-forward pattern for erector spinae and multifidus activation relative to deltoid onset [3,17,21,23,47]. A major element of the present study is that EMG recordings were made at commonly fractured sites, and from the paraspinal muscles, which are known to contribute significantly to compressive vertebral loading due to their short moment arm, particularly in individuals with vertebral fractures [13]. Although EMG was not collected from participantspecific fracture levels, the majority of fractures sustained by participants in this study occurred at T6, in agreement with previous reports [7,11].…”

Section: Discussionsupporting

confidence: 92%

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Paraspinal muscle control in people with osteoporotic vertebral fracture

et al. 2007

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The high risk of sustaining subsequent vertebral fractures after an initial fracture cannot be explained solely by low bone mass. Extra-osseous factors, such as neuromuscular characteristics may help to explain this clinical dilemma. Elderly women with (n = 11) and without (n = 14) osteoporotic vertebral fractures performed rapid shoulder flexion to perturb the trunk while standing on a flat and short base. Neuromuscular postural responses of the paraspinal muscles at T6 and T12, and deep lumbar multifidus at L4 were recorded using intramuscular electromyography (EMG). Both groups demonstrated bursts of EMG that were initiated either before or shortly after the onset of shoulder flexion (P < 0.05). Paraspinal and multifidus onset occurred earlier in the non-fracture group (50-0 ms before deltoid onset) compared to the fracture group (25 ms before and 25 ms after deltoid onset) in the flat base condition. In the short base condition, EMG amplitude increased significantly above baseline earlier in the non-fracture group (75-25 ms before deltoid onset) compared to the fracture group (25-0 ms before deltoid onset) at T6 and T12; yet multifidus EMG increased above baseline earlier in the fracture group (50-25 ms before deltoid) compared to the non-fracture group (25-0 ms before deltoid). Time to reach maximum amplitude was shorter in the fracture group. Hypothetically, the longer time to initiate a postural response and shorter time to reach maximum amplitude in the fracture group may indicate a neuromuscular contribution towards subsequent fracture aetiology. This response could also be an adaptive characteristic of the central nervous system to minimise vertebral loading time.

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Section: Discussionsupporting

confidence: 92%

“…This suggests that factors other than BMD may influence the aetiology of first-time and subsequent vertebral fracture [4]. Local factors such as cortical bone structure [33], bone quality [1] and bone geometry [13] appear to have an influential role. However, extraosseous factors may also influence vertebral fracture aetiology.…”

Section: Introductionmentioning

confidence: 99%

Paraspinal muscle control in people with osteoporotic vertebral fracture

et al. 2007

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“…The fracture-induced changes in vertebral morphology causing greater flexion moments locally and in adjacent vertebral levels may perpetuate morphologic changes and increase subsequent fracture risk. Contributions of vertebral geometry [24], densitometry [4] and bone quality characteristics [1,41] in individuals with fractures are also likely to account for some of this increased risk. Shear forces were greater at the level of fracture and one level above, while compression forces were greater at one level below in the fracture compared to equivalent level mean forces of the non-fracture group.…”

Section: Discussionmentioning

confidence: 99%

The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo

et al. 2006

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The aetiology of osteoporotic vertebral fractures is multi-factorial, and cannot be explained solely by low bone mass. After sustaining an initial vertebral fracture, the risk of subsequent fracture increases greatly. Examination of physiologic loads imposed on vertebral bodies may help to explain a mechanism underlying this fracture cascade. This study tested the hypothesis that model-derived segmental vertebral loading is greater in individuals who have sustained an osteoporotic vertebral fracture compared to those with osteoporosis and no history of fracture. Flexion moments, and compression and shear loads were calculated from T2 to L5 in 12 participants with fractures (66.4 ± 6.4 years, 162.2 ± 5.1 cm, 69.1 ± 11.2 kg) and 19 without fractures (62.9 ± 7.9 years, 158.3 ± 4.4 cm, 59.3 ± 8.9 kg) while standing. Static analysis was used to solve gravitational loads while muscle-derived forces were calculated using a detailed trunk muscle model driven by optimization with a cost function set to minimise muscle fatigue. Least squares regression was used to derive polynomial functions to describe normalised load profiles. Regression co-efficients were compared between groups to examine differences in loading profiles. Loading at the fractured level, and at one level above and below, were also compared between groups. The fracture group had significantly greater normalised compression (p = 0.0008) and shear force (p < 0.0001) profiles and a trend for a greater flexion moment profile. At the level of fracture, a significantly greater flexion moment (p = 0.001) and shear force (p < 0.001) was observed in the fracture group. A greater flexion moment (p = 0.003) and compression force (p = 0.007) one level below the fracture, and a greater flexion moment (p = 0.002) and shear force (p = 0.002) one level above the fracture was observed in the fracture group. The differences observed in multi-level spinal loading between the groups may explain a mechanism for increased risk of subsequent vertebral fractures. Interventions aimed at restoring vertebral morphology or reduce thoracic curvature may assist in normalising spine load profiles.

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“…There was no difference in body height between the allelic variants, indicating an influence of the TNF-a 2 863 polymorphism on bone size. Previous studies (8,31,32) have emphasized the importance of bone size as a determinant of bone strength. Further supporting the role of TNF-a in determining bone size, is the observed independent correlation of TNF-a plasma levels to lumbar spine area.…”

Section: Discussionmentioning

confidence: 99%

“…It is not only mineral density of the skeleton that is important for bone strength. Bone size is a significant determinant for fractures of the vertebral bodies, as Gilsanz et al (8) have shown. Even small changes in size, particularly in external diameter, have a major effect on mechanical properties of a bone (9).…”

Section: Introductionmentioning

confidence: 96%

TNF-alpha gene polymorphism and plasma TNF-alpha levels are related to lumbar spine bone area in healthy female Caucasian adolescents

Wennberg

Lorentzon²,

Lerner³

et al. 2002

European Journal of Endocrinology

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Objective: The cytokine tumor necrosis factor alpha (TNF-a) is an important regulator of bone metabolism. Polymorphisms in the promoter region of the TNF-a gene at positions 2 308 and 2 863 have been identified. We investigated whether these polymorphisms and circulating TNF-a levels were related to bone mineral density and bone area in adolescent girls. Design: Bone mineral density (BMD), bone area (BA), anthropometric characteristics and biochemical analyses were measured in adolescent girls and compared with regard to TNF-a genotype. Methods: Allelic variants of the TNF-a gene in 97 girls, aged 16:9^1:2 years (mean^S.D.), were identified using polymerase chain reaction and the restriction endonucleases NcoI and TaiI. Bone mineral density and bone area of the femoral neck, lumbar spine and total body were measured using dual energy X-ray absorptiometry. Results: Carriers of the rare 2863 A allele ðn ¼ 25Þ had higher body weight ðP ¼ 0:03Þ; lumbar spine BMD ðP ¼ 0:02Þ; and larger total BA ðP ¼ 0:03Þ; femoral neck area ðP , 0:05Þ; and lumbar spine area ðP ¼ 0:01Þ: The independent predictors of BMD and BA were investigated using multiple regression. The TNF-a 2 863 genotypes ðb ¼ 0:18; P ¼ 0:03Þ and the TNF-a plasma levels ðb ¼ 0:19; P ¼ 0:04Þ independently predicted BA of the lumbar spine but not BA or BMD of any other measured sites. No statistically significant differences in body constitution parameters, biochemical parameters, bone density, or bone area at the measured skeletal sites were found when comparing the groups defined by the allelic variants at position 2 308 ðP ¼ 0:17 -0:84Þ: Conclusions: We found the TNF-a 2 863 polymorphism and the TNF-a plasma levels to be independent predictors of lumbar spine area in healthy Caucasian adolescent females.

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Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures.

Cited by 149 publications

References 29 publications

Paraspinal muscle control in people with osteoporotic vertebral fracture

Paraspinal muscle control in people with osteoporotic vertebral fracture

The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo

TNF-alpha gene polymorphism and plasma TNF-alpha levels are related to lumbar spine bone area in healthy female Caucasian adolescents

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