BIOMECHANICS OF VERTEBRAL FRACTURE RISK

高发病率和患病率、发病年份和 生活质量的显著变化使老年人脊柱骨折 老年人是一个主要的公共卫生问题。该病的总发病率 临床诊断脊柱骨折每千人年L以上， 而且发病率随着年龄的增长而急剧增加，大约在L 80岁以上妇女每100人年发生骨折。临床后果 包括生活质量降低、身高下降、急性和慢性 疼痛。脊椎骨折归因于与年龄相关的骨丢失和 骨骼结构的变化，但很少有人关注 这些骨折的病因和生物力学。这项研究的第一个目标 是为了得出一个强有力的、有意义的脊椎骨折预测指标 来自双能X射线吸收法(DXA)的强度。新方法论 将用于确定椎体的横截面几何形状 从侧面DXA扫描的身体。身体胸椎的骨折试验 样本将被用来开发极限载荷的最强预测值。 在基于DXA的变量中。第二个目标将是调查 老年脊柱骨折患者的病因调查 贝丝以色列医院急诊室和病房的脊椎骨折。 有突发性背部疼痛的对照受试者也将接受采访。 赛事期间脊柱上的负荷将根据编撰的 在调查期间进行的活动和人体测量。准- 将使用脊柱负荷的静态优化模型。这些负载在 脊椎将在两组人之间进行比较，以努力确定 这些活动与增加脊椎骨折的风险有关。这个 这项建议的第三个目标是测试两个脊椎的最终负荷 由DXA导出和从数学推导得出的估计应用负载 模型和调查与脊柱骨折显著相关 年长的样本。总体目标是结合对一项 测量脊椎强度的损伤事件。这些概念可以 合并到一个称为风险系数的变量中，这是 应用脊柱载荷除以估计的脊椎极限载荷。这个 这一因素之间潜在关联的意义和强度 将检查风险和脊椎骨折的存在。这个 这项调查的结果可能直接关系到预防 通过确定与老年人受伤相关的活动来评估老年人的伤害 增加了骨折的风险，还通过确定基于DXA的性能 与骨折有关的腰椎。如果活动和 风险增加的个人被认识到，结果将提供 支持制定和应用下列对策 将改变行为的教育或治疗干预纳入其中 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.