Architecture and distribution of cancellous bone yield vertebral fracture clues:​ a histomorphometric analysis of the complete spinal column from 40 autopsy specimens

Amling, M.; Pösl, M.; Ritzel, H.; Hahn, M.; Vogel, M.; Wening, V. J.; Delling, G.

Affiliations

¹Department of Bone Pathology, Institute of Pathology, Center for Biomechanics UKE, University of Hamburg, Martinistrasse 52, D-20246, Hamburg, Germany

²Present address: Department of Orthopedics and Cell Biology, Yale University, School of Medicine, 333 Cedar Street, SHM IE-65, New Haven, 06510, USA

³Department of Orthopedics, Center for Biomechanics UKE, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany

⁴Department of Trauma Surgery, Center for Biomechanics UKE, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany

Abstract

The objective of this study was to analyze the structure of cancellous bone and its significance for vertebral fractures. Therefore, the complete spinal column from 40 autopsy cases (18 without diseases affecting the skeleton and 12 osteoporotic) was removed and sectioned in the sagittal plane to a thickness of 1 mm. A surface-stained block grinding technique allowed combined two- and three-dimensional histomorphometric analysis, which included an evaluation of the trabecular bone volume (BV/TV in %) and the trabecular interconnection (TBPf, in mm). In addition, qualitative investigation of the structure of trabecular bone was done. The distribution of trabecular bone volume within the spinal column of a normal skeleton shows a curve, with the highest values in the cervical spine and a decline in the thoracic and lumbar spine. Osteoporosis presents itself with a pathologically diminished trabecular bone volume, whereas the distribution within the spine is comparable to that of the controls. Osteoporotic patients show an apparently reduced trabecular interconnection. It is important that the measured values for TBPf are not only in general higher, but also more widely dispersed. The age-related decrease of trabecular bone mass is due to the transformation from plates to rods. This is quantitatively indicated by the close correlation of BV/TV and TBPf (P < 0.001, r = 0.85). The bone loss in osteoporosis is a loss of structure and a loss of whole trabeculae, which is caused by perforations. It involves a gradual change from normal bone. However, the polyostic heterogenity in osteoporosis is immense. These structural differences demonstrate the development of regions of least resistance within the spine, serving as an explanation of osteoporotic fractures. Due to the polyostotic heterogeneity it is impossible to define a threshold mineral content for crash fractures by diagnostic measurements at any reference site.

Links

DOI: 10.1007/BF00439050

PubMed: 8836458

WoS: A1996UX14800004

History

Received: 1995-08-18

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2009	Busse B, Hahn M, Soltau M, Zustin J, Püschel K, Duda GN, Amling M. Increased calcium content and inhomogeneity of mineralization render bone toughness in osteoporosis: mineralization, morphology and biomechanics of human single trabeculae. Bone. December 2009;45(6):1034-1043.
2000	Saha PK, Gomberg BR, Wehrli FW. Three-dimensional digital topological characterization of cancellous bone architecture. Int J Imaging Syst Technol. 2000;11(1):81-90.
2005	Gong H, Zhang M, Yeung HY, Qin L. Regional variations in microstructural properties of vertebral trabeculae with aging. J Bone Min Metab. March 2005;23(2):174-180.
2001	Simpson EK, Parkinson IH, Manthey B, Fazzalari NL. Intervertebral disc disorganization is related to trabecular bone architecture in the lumbar spine. J Bone Miner Res. April 2001;16(4):681-687.
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2007	Boyd LM. Effects of a Genetic Mutation in Type IX Collagen on Morphology and Metabolism in a Murine Model of Intervertebral Disc Degeneration [PhD thesis]. Duke University; 2007.
2018	Khor F. Computational Modeling of Hard Tissue Response and Fracture in the Lower Cervical Spine Under Compression Including Age Effects [Master's thesis]. University of Waterloo; 2018.
2024	Benais R. Computational Modeling of Trabecular Bone Indentation and Development of a New Test Method to Perform Unconstrained Load-Induced Subsidence of an Intervertebral Body Fusion Device [Master's thesis]. University of Waterloo; 2024.