BIOMECHANICS OF VERTEBRAL FRACTURE RISK

高发病率、高患病率、高发病年限、高发病率 生活质量的显著变化使椎体骨折的发生率 老年人是一个主要的健康问题。 的总体发生率 临床诊断的椎骨骨折超过1/1000人-年， 发病率随着年龄的增长而急剧增加， 80岁以上女性每100人-年的骨折发生率。 的临床后果 包括生活质量下降、身高下降以及急性和慢性 痛苦脊椎骨折是由于年龄相关的骨质流失， 骨结构的变化，但很少注意到 这些骨折的病因和生物力学。本研究的第一个目标是 是为了得到一个强有力的，有意义的预测脊椎骨折 双能X线吸收法（DXA）。新方法 将用于确定椎骨的横截面几何形状 侧面DXA扫描的尸体尸体胸椎骨折试验 试件将用于开发极限载荷的最强预测器 在DXA的变量中。第二个目标是调查 老年人椎体骨折的病因调查 贝斯以色列医院急诊室和病房的脊椎骨折 还将对突发背痛的对照受试者进行访谈。 将根据编码的 调查期间进行的活动和人体测量。准- 将使用脊柱载荷的静态优化模型。这些负载 将在两组之间比较脊柱， 与椎骨骨折风险增加相关的活动。的 本建议的第三个目标是测试极限椎骨载荷 从DXA推导出的估计施加载荷和从数学推导出的估计施加载荷 模型和调查与脊椎骨折显著相关， 老年人样本 总体目标是将对一个 损伤事件与椎骨强度测量。这些概念可以 被合并到一个变量中，称为风险因素，即 施加的脊柱载荷除以估计的椎骨极限载荷。 的 该因素之间潜在关联的显著性和强度 的风险和脊椎骨折的存在将被检查。的 这项调查的结果可能直接关系到预防 通过识别与老年人相关的活动， 增加骨折的风险，并通过确定DXA为基础的属性， 与骨折有关的腰椎。如果活动和 风险增加的个体得到确认，结果将提供 支持制定和应用反措施， 将教育纳入改变行为或治疗干预， 保持骨量和结构。

The high incidence and prevalence rates, the years of morbidity, and the significant change in the quality of life make vertebral fractures in the elderly a major publiC health problem. The overall incidence rate of clinically diagnosed vertebral fractures is over l per 1000 person-years, and the incidence rate increases dramatically with age to approximately l fracture per 100 person-years in women over 80. The clinical consequences include a lower quality of life, loss of height, and acute and chronic pain. Vertebral fractures are attributed to age-related bone loss and changes in bone architecture, but little attention has been given to the etiology and biomechanics of these fractures. The first goal of this study is to derive a strong, significant predictor of vertebral fracture strength from dual--energy x-ray absorptiometry (DXA). New methodology will be used to determine the cross-sectional geometry of the vertebral body from lateral DXA scans. Fracture tests of cadaveric thoracic specimens will be used to develop the strongest predictor of ultimate load among DXA-based variables. The second goal will be to investigate the etiology of vertebral fracture in the elderly by surveying patients with vertebral fracture from the Beth Israel Hospital Emergency Unit and Wards. Control subjects with sudden onset of back pain will also be interviewed. Loads on the spine during the event will be estimated from the codified activities and anthropometric measures made during the survey. Quasi- static optimization models of spinal loading will be used. These loads on the spine will be compared between the two groups in an effort to identify those activities associated with increased risk of vertebral fracture. The third goal of this proposal is to test if both the ultimate vertebral load derived from DXA and the estimated applied load derived from mathematical models and surveys associate significantly with vertebral fracture in an elderly sample. The overall aim is to couple an investigation of an injury event with a measurement of vertebral strength. These concepts can be combined in one variable called the factor of risk, which is the applied spinal load divided by the estimated vertebral ultimate load. The significance and strength of the potential association between this factor of risk and the presence of vertebral fracture will be examined. The results of this investigation could have direct bearing on the prevention of injury in the elderly by identifying activities associated with an increased risk of fracture and also by identifying DXA-based properties of the lumbar spine that associate with fracture. If activities and individuals at increased risk are recognized, the results would offer support to the development and application of countermeasures that incorporate education to alter behavior or to therapeutic interventions to maintain bone mass and architecture.