Lumbar trabecular bone mineral density distribution in patients with and without vertebral fractures: a case-control study.
OBJECTIVE
The proportion of load transmitted through the lumbar neural arch increases with aging, spinal degeneration, and lordosis, effectively shielding the lumbar vertebral bodies from load. This stress shielding may contribute to bone loss in the vertebral body, leading to increased fracture risk. To test his hypothesis, we performed a study to determine if vertebral body fractures were associated with a higher neural arch/vertebral body volumetric bone mineral density (vBMD) ratio.


METHODS
Trabecular vBMD was calculated by quantitative CT in the L3 vertebral body and neural arch (pars interarticularis) of 36 women with vertebral compression fractures and 39 controls. Neural arch/vertebral body vBMD ratio was calculated, and its relationship to fracture status was determined using linear regression models adjusted for age and body mass index.


RESULTS
Vertebral body trabecular vBMD was lower in fracture cases as compared to controls (mean ± SD, 49.0 ± 36.0 vs. 87.5 ± 36.8 mg/cm(3), respectively; P < 0.001), whereas trabecular vBMD of the neural arch was similar (96.1 ± 57.6 in cases vs. 118.2 ± 57.4 mg/cm(3) in controls; P = 0.182). The neural arch/vertebral body vBMD ratio was significantly greater in the fracture group than in controls (2.31 ± 1.07 vs. 1.44 ± 0.57, respectively; P < 0.001).


CONCLUSIONS
These results support the hypothesis that stress shielding is a contributor to vertebral body bone loss and may increase fracture risk. Although further studies are needed, there may be a role for interventions that can shift vertebral loading in the spine to help prevent fracture.
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Hugo
H
Giambini
Reza
R
Salman Roghani
Andrew R
AR
Thoreson
L Joseph
LJ
Melton
Kai-Nan
KN
An
Ralph E
RE
Gay
D000368:Aged; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging*; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed