Biomechanics of Vertebral Fractures: The Framingham QCT Study

椎骨骨折的生物力学：Framingham QCT 研究

• 批准号: 8629631
• 负责人: MARY L BOUXSEIN
• 金额: $ 71.31万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-15 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8629631
• 关键词: Accounting; Address; Affect; Age; Area; Biomechanics; Bone Density; Chest; Clinical; Clinical Data; Deterioration; Development; Dual-Energy X-Ray Absorptiometry; Elderly; Environment; Etiology; Fatty acid glycerol esters; Finite Element Analysis; Fracture; Framingham Heart Study; Funding; Growth; Heterogeneity; Individual; Intervention; Knowledge; Kyphosis deformity of spine; Lead; Lordosis; Measures; Mechanics; Modeling; Morbidity - disease rate; Morphology; Muscle; Musculoskeletal; Patients; Population; Predisposition; Probability; Prospective Studies; Public Health; Research; Risk; Risk Assessment; Risk Factors; Scanning; Specimen; Spinal; Spinal Curvatures; Spinal Fractures; Testing; Variant; Vertebral column; Woman; Work; age related; aging gene; base; bone; case control; cohort; cost; density; experience; high risk; improved; in vivo; innovation; insight; interdisciplinary approach; men; mortality; multidisciplinary; novel; novel strategies; population based; prevent; prospective; public health relevance; sex; spine bone structure; tool; vertebra body

Project Summary Vertebral fractures (VF) are the most common fracture among older persons, afflicting 20-35% of women and 15-25% of men >50 yrs, and leading to profound morbidity, increased mortality, and costs exceeding $1 billion in the US annually. There is strong evidence that factors other than low bone mineral density (BMD) influence VF risk. Yet, the biomechanical factors that contribute to fractures are poorly understood. From a mechanical perspective, a VF occurs when loads applied to the vertebrae exceed its strength. Thus, in this competing renewal, we aim to study several factors that our recent work indicates are related to VF risk, either by affecting vertebral loading and/or vertebral strength. We will build upon our prior cross-sectional findings by studying several novel factors that may contribute to incident vertebral fractures in two, well-characterized cohorts: the Framingham Heart Study Multidetector CT Study and the Age, Gene/Environment Susceptibility- Reykjavik Study (AGES). In the last funding period, we showed that estimates of vertebral loading are highly sensitive to several factors, namely variations in spine curvature, trunk muscle size and trunk muscle density that were not accounted for in our (and others') prior studies and likely led to errors in the in vivo estimates of vertebral loading. Our preliminary data also show that a novel measure of heterogeneity in the distribution of bone density within the vertebral body is associated with vertebral strength in cadaveric specimens and with prevalent VF, even after adjusting for BMD. Thus we propose to conduct a prospective study of incident VF to determine the contribution of 1) spinal curvature, 2) the size and quality of trunk muscles; and 3) the distribution of bone density within the vertebral body to VF. Further, we will test whether a patient-specific factor-of-risk (ie, load-to-strength ratio) that uses state-of-the art approaches to estimate vertebral strength and in vivo spinal loading predicts incident VF better than aBMD or FRAX alone. In summary, this project is significant because it addresses the need to reduce the growing burden of VF. The proposal is highly innovative and efficient by using existing QCT and clinical data from well-characterized prospective population- based cohorts, along with an experienced team and multidisciplinary approach to gain knowledge about the etiology of VF. Completion of the proposed work will ultimately shift the current paradigm for VF etiology "beyond BMD", thereby pointing towards new approaches to identify those at risk for fracture and novel interventions to reduce the occurrence of VF.

项目摘要 脊椎骨折（VF）是老年人中最常见的骨折，20-35%的妇女受到影响， 15-25%的男性>50岁，并导致严重的发病率，死亡率增加，成本超过10亿美元 每年在美国。有强有力的证据表明，低骨密度（BMD）以外的因素影响 VF风险。然而，导致骨折的生物力学因素知之甚少。从机械 从这个角度来看，当施加到椎骨上的载荷超过其强度时发生VF。因此，在这场竞争中， 更新，我们的目标是研究我们最近的工作表明与VF风险相关的几个因素， 影响椎骨负荷和/或椎骨强度。我们将在之前的横断面调查结果的基础上， 研究了可能导致两个特征良好的椎骨骨折的几个新因素， 队列：心脏研究多探测器CT研究和年龄、基因/环境易感性- 雷克雅未克研究（AGES）。在上一个资助期，我们发现脊椎负荷的估计值很高， 对几个因素敏感，即脊柱弯曲度、躯干肌肉大小和躯干肌肉密度的变化 这在我们（和其他人）先前的研究中没有考虑到，可能导致体内估计的错误。 椎体负荷我们的初步数据还表明，一种新的测量异质性的分布， 椎体内的骨密度与尸体标本中的椎体强度相关， 普遍VF，即使在调整BMD后。因此，我们建议对突发VF进行前瞻性研究， 确定1）脊柱弯曲，2）躯干肌肉的大小和质量;以及3） 椎体内的骨密度分布与VF相关。此外，我们将测试是否有患者特异性 使用最先进的方法估计椎骨强度的风险系数（即，载荷-强度比）， 体内脊柱负荷预测VF事件优于单独的aBMD或FRAX。综上所述，该项目是 重要的是，它解决了减少日益增长的VF负担的需要。该提案高度 通过使用现有的QCT和来自良好表征的前瞻性人群的临床数据， 基于队列，沿着经验丰富的团队和多学科方法，以获得有关 VF的病因完成拟议的工作将最终改变目前的VF病因学范式 “超越BMD”，从而指向新的方法来识别那些有骨折风险的人， 干预措施，以减少VF的发生。