Structural determinants of vertebral fracture risk
Structural determinants of vertebral fracture risk
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DOI：
10.1359/jbmr.070728
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发表时间：
2007-12-01
影响因子：
6.2
通讯作者：
Khosla, Sundeep
中科院分区：
文献类型：
--
作者：
Melton, L. Joseph, III;Riggs, B. Lawrence;Khosla, Sundeep
椎体骨折与特定骨密度、结构和强度参数的相关性比与区域BMD的相关性更强，但所有这些变量都是相关的。引言：目前尚不清楚区域BMD（aBMD）与椎体骨折风险的相关性是否取决于骨密度本身、骨宏观或微观结构、总体骨强度或脊柱负荷/骨强度比。我们从明尼苏达州罗切斯特的女性年龄分层样本中，确定了40名临床诊断为中度创伤引起的椎骨骨折（经血清定量证实）（例;平均年龄，78.6 ± 9.0岁），并将其与40名无骨质疏松性骨折的对照组进行比较（平均年龄，70.9 ± 6.8岁）。腰椎体积BMD（vBMD）和几何形状通过中央QCT进行评估，而微观结构通过高分辨率pQCT在超远端桡骨进行评估。从基于体素的有限元模型估计椎骨失效载荷（类似于强度），并且将风险因子（（））确定为施加的脊柱载荷与失效载荷的比率。90 °前屈，2639与2706 N;年龄调整后p = 0.173）。然而，骨折病例的大多数骨密度和结构变量值较低。骨强度指标也降低了，在脊椎骨折的女性中，风险因素增加了35-37%。通过年龄调整的逻辑回归分析，五个主要变量类别中最强的骨折预测因子的相对风险是骨密度（总腰椎vBMD：OR/SD变化，2.2; 95% CI，1.1-4.3），骨几何结构（椎体表观皮质厚度：OR，2.1; 95% CI，1.1-4.1），骨显微结构（无显著性）;骨强度（“皮质”[外部2 mm]抗压强度：OR，2.5; 95% CI，1.3-4.8）和风险因素（（90 °前屈/整体椎体压缩强度：OR，3.2; 95% CI，1.4-7.5）。这些变量与脊柱aBMD（部分r，-0.32至0.75），但每一个都是一个更强的预测骨折的logistic回归analysis.Conclusions：aBMD与椎骨骨折风险的关联解释其相关性与更具体的骨密度，结构和强度参数。这些可以使更深入的了解骨折的发病机制。
Vertebral fractures are more strongly associated with specific bone density, structure, and strength parameters than with areal BMD, but all of these variables are correlated.Introduction: It is unclear whether the association of areal BMD (aBMD) with vertebral fracture risk depends on bone density per se, bone macro- or microstructure, overall bone strength, or spine load/bone strength ratios.Materials and Methods: From an age-stratified sample of Rochester, MN, women, we identified 40 with a clinically diagnosed vertebral fracture (confirmed serniquantitatively) caused by moderate trauma (cases; mean age, 78.6 +/- 9.0 yr) and compared them with 40 controls with no osteoporotic fracture (mean age, 70.9 +/- 6.8 yr). Lumbar spine volumetric BMD (vBMD) and geometry were assessed by central QCT, whereas microstructure was evaluated by high-resolution pQCT at the ultradistal radius. Vertebral failure load (similar to strength) was estimated from voxel-based finite element models, and the factor-of-risk (() was determined as the ratio of applied spine loads to failure load.Results: Spine loading (axial compressive force on L-3) was similar in vertebral fracture cases and controls (e.g., for 90 degrees forward flexion, 2639 versus 2706 N; age-adjusted p = 0.173). However, fracture cases had inferior values for most bone density and structure variables. Bone strength measures were also reduced, and the factor-of-risk was 35-37% greater (worse) among women with a vertebral fracture. By age-adjusted logistic regression, relative risks for the strongest fracture predictor in each of the five main variable categories were bone density (total lumbar spine vBMD: OR per SD change, 2.2; 95% CI, 1.1-4.3), bone geometry (vertebral apparent cortical thickness: OR, 2.1; 95% CI, 1.1-4.1), bone microstructure (none significant); bone strength ("cortical" [outer 2 mm] compressive strength: OR, 2.5; 95% CI, 1.3-4.8), and factor-of-risk (( for 90 degrees forward flexion/overall vertebral compressive strength: OR, 3.2; 95% CI, 1.4-7.5). These variables were correlated with spine aBMD (partial r, -0.32 to 0.75), but each was a stronger predictor of fracture in the logistic regression analyses.Conclusions: The association of aBMD with vertebral fracture risk is explained by its correlation with more specific bone density, structure, and strength parameters. These may allow deeper insights into fracture pathogenesis.