Age- and sex-specific differences in the factor of risk for vertebral fracture: a population-based study using QCT.
We used QCT scans obtained in 687 men and women, 21-97 years of age, to estimate the factor of risk for vertebral fracture, Phi(vert), defined as the ratio of spinal loading to vertebral strength. With age, vertebral strength declined and Phi(vert) increased significantly more in women than men. Age- and sex-specific differences in Phi(vert) closely resembled previously reported vertebral fracture incidence.


BACKGROUND
Despite the high prevalence of vertebral fractures, little is known about the interaction between spinal loading and vertebral fragility.


METHODS
We assessed the ratio of spinal loading to vertebral strength (i.e., the factor of risk, Phi(vert)) in an age- and sex-stratified population-based sample of 700 women and men 21-97 years of age. We measured volumetric BMD (vBMD, mg/cm3) and cross-sectional area (CSA, cm2) of the midvertebral bodies of L1-L3 using QCT and computed vertebral compressive strength from these data using engineering beam theory. A biomechanical model of the trunk was used to estimate compressive forces applied to the L3 vertebral body during standing, bending forward, and bending forward while lifting 10 kg. The factor of risk for fracture, Phi(vert), was computed as the ratio of spinal compressive force to vertebral strength for each activity.


RESULTS
Men had a higher vertebral strength at all ages, largely because of their greater CSA. Whereas both sexes exhibited a marked decline in vertebral compressive strength with age (p < 0.001), the decline was greater in women than men (-43% versus -31%, p = 0.008). Compressive forces on L3 were greater in men than women, because of their greater body weight and height. For both sexes, forces during bending and lifting were 8-fold higher than those experienced during upright standing. For all activities, Phi(vert) increased with age, but significantly more so in women than men (p < 0.001). For bending and lifting, Phi(vert-bending) exceeded 1.0 in 30% of women and 12% of men > or =50 years of age, values that are similar to the reported frequency of vertebral fracture.


CONCLUSIONS
These findings illustrate potential mechanisms underlying vertebral fractures and provide strong rationale for further evaluation of this QCT-based biomechanical approach for assessment of fracture risk.
Bouxsein
Mary L
ML
Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. mbouxsei@bidmc.harvard.edu
Melton
L Joseph
LJ
Riggs
B Lawrence
BL
Muller
John
J
Atkinson
Elizabeth J
EJ
Oberg
Ann L
AL
Robb
Richard A
RA
Camp
Jon J
JJ
Rouleau
Peggy A
PA
McCollough
Cynthia H
CH
Khosla
Sundeep
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D019245:Compressive Strength; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D017770:Lifting / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D012727:Sex Characteristics; D016103:Spinal Fractures / Q000453:epidemiology*; D013124:Spinal Injuries / Q000453:epidemiology*; D013131:Spine / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013718:Tensile Strength; D015898:Tomography Scanners, X-Ray Computed; D016474:Weight-Bearing