Bone density and strength from thoracic and lumbar CT scans both predict incident vertebral fractures independently of fracture location

Johannesdottir, F.<sup>1,2</sup>; Allaire, B.<sup>1</sup>; Kopperdahl, D. L.<sup>3</sup>; Keaveny, T. M.<sup>4,5</sup>; Sigurdsson, S.<sup>6</sup>; Bredella, M. A.<sup>2,7</sup>; Anderson, D. E.<sup>1,2</sup>; Samelson, E. J.<sup>2,8,9</sup>; Kiel, D. P.<sup>2,8,9</sup>; Gudnason, V. G.<sup>6,10</sup>; Bouxsein, M. L.<sup>1,2</sup>

Affiliations

¹Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, RN115, 330 Brookline Avenue, Boston, MA 02215, USA

²Harvard Medical School, Boston, MA, USA

³O.N. Diagnostics LLC, Berkeley, CA, USA

⁴Department of Mechanical Engineering, University of California, Berkeley, CA, USA

⁵Department of Bioengineering, University of California, Berkeley, CA, USA

⁶Icelandic Heart Association, Kopavogur, Iceland

⁷Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

⁸Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

⁹Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA

¹⁰Department of Medicine, University of Iceland, Reykjavik, Iceland

Abstract and keywords

Summary: In a population-based study, we found that computed tomography (CT)-based bone density and strength measures from the thoracic spine predicted new vertebral fracture as well as measures from the lumbar spine, suggesting that CT scans at either the thorax or abdominal regions are useful to assess vertebral fracture risk.

Introduction: Prior studies have shown that computed tomography (CT)-based lumbar bone density and strength measurements predict incident vertebral fracture. This study investigated whether CT-based bone density and strength measurements from the thoracic spine predict incident vertebral fracture and compared the performance of thoracic and lumbar bone measurements to predict incident vertebral fracture.

Methods: This case-control study of community-based men and women (age 74.6 ± 6.6) included 135 cases with incident vertebral fracture at any level and 266 age- and sex-matched controls. We used baseline CT scans to measure integral and trabecular volumetric bone mineral density (vBMD) and vertebral strength (via finite element analysis, FEA) at the T8 and L2 levels. Association between these measurements and vertebral fracture was determined by using conditional logistic regression. Sensitivity and specificity for predicting incident vertebral fracture were determined for lumbar spine and thoracic bone measurements.

Results: Bone measurements from T8 and L2 predicted incident vertebral fracture equally well, regardless of fracture location. Specifically, for predicting vertebral fracture at any level, the odds ratio (per 1-SD decrease) for the vBMD and strength measurements at L2 and T8 ranged from 2.0 to 2.7 (p < 0.0001) and 1.8 to 2.8 (p < 0.0001), respectively. Results were similar when predicting fracture only in the thoracic versus the thoracolumbar spine. Lumbar and thoracic spine bone measurements had similar sensitivity and specificity for predicting incident vertebral fracture.

Conclusion: These findings indicated that like those from the lumbar spine, CT-based bone density and strength measurements from the thoracic spine may be useful for identifying individuals at high risk for vertebral fracture.

Keywords: Finite element analysis; Fracture prediction; Osteoporosis; QCT; Vertebral fracture

Links

DOI: 10.1007/s00198-020-05528-4

PubMed: 32748310

WoS: 000555388200001

History

Received: 2020-02-25

Accepted: 2020-06-30

Online: 2020-08-03

Cited Works (10)

Year	Entry
1993	Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. September 1993;8(9):1137-1148.
2004	Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JPTM, Pols HAP. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. January 2004;34(1):195-202.
2006	Sigurdsson G, Aspelund T, Chang M, Jonsdottir B, Sigurdsson S, Eiriksdottir G, Gudmundsson A, Harris TB, Gudnason V, Lang TF. Increasing sex difference in bone strength in old age: the age, gene/environment susceptibility-Reykjavik study (AGES-REYKJAVIK). Bone. September 2006;39(3):644-651.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
1999	Black DM, Arden NK, Palermo L, Pearson J, Cummings SR; Study of Osteoporotic Fractures Research Group. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res. May 1999;14(5):821-828.
2008	Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N. A reference standard for the description of osteoporosis. Bone. March 2008;42(3):467-475.
2016	Khosla S, Shane E. A crisis in the treatment of osteoporosis. J Bone Miner Res. August 2016;31(8):1485-1487.
2014	Kopperdahl DL, Aspelund T, Hoffmann PF, Sigurdsson S, Siggeirsdottir K, Harris TB, Gudnason V, Keaveny TM. Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans. J Bone Miner Res. March 2014;29(3):570-580.
2012	Wang X, Sanyal A, Cawthon PM, Palermo L, Jekir M, Christensen J, Ensrud KE, Cummings SR, Orwoll E, Black DM, Keaveny TM; Osteoporotic Fractures in Men (MrOS) Research Group. Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res. April 2012;27(4):808-816.
2007	Burge R, Dawson‐Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis‐related fractures in the United States, 2005–2025. J Bone Miner Res. March 2007;22(3):465-475.

Cited By (1)

Year	Entry
2023	Gao X, Din RU, Cheng X, Yang H. Biomechanical MRI detects reduced bone strength in subjects with vertebral fractures. Bone. August 2023;173:116810.