title: Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury.
abstract: The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p < 0.001), lumbar (p = 0.005), trochanteric (p = 0.002), intertrochanteric (p < 0.001), and total hip (p = 0.0006) BMD T-scores. The odds of having a femoral neck (OR 0.24, 95% CI 0.07-0.75, p = 0.01) or total hip (OR 0.19, 95% CI 0.06-0.65, p = 0.008) T-score less than -2.5 was also lower among patients with vertebral fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.
authors.affiliation: Division of Geriatric Medicine, University of Toronto, 4-002 Shuter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. jennifer.watt@mail.utoronto.ca.
authors.forename: Jennifer
authors.identifier: 0000-0002-5296-6013
authors.initials: J
authors.lastname: Watt
authors.affiliation: Division of Geriatric Medicine, University of Western Ontario, London, ON, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Crilly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology*; D005260:Female; D005269:Femur / Q000293:injuries; D005272:Femur Neck / Q000503:physiopathology; D006620:Hip Fractures / Q000503:physiopathology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D010024:Osteoporosis / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography / Q000379:methods; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000293:injuries*
keywords: Bone density; Osteoporosis; Risk factors; Spinal fracture; Trauma