Skip to main content
SpringerLink
Log in

Severity of vertebral fracture reflects deterioration of bone microarchitecture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Introduction

Bone microarchitecture, a component of bone strength, is generally measured on transiliac bone biopsy samples. The objective of this study was to determine whether assessment of four grades of vertebral fracture severity could serve as a noninvasive surrogate marker for trabecular bone volume and microarchitecture.

Methods

Baseline vertebral fracture severity was determined by semiquantitative assessment of spine radiographs from 190 postmenopausal women with osteoporosis. Bone-structure indices were obtained by 2D histomorphometry and 3D microcomputed tomography (CT) analyses. Significance of differences was determined after adjusting for age, height, and lumbar spine bone mineral density.

Results

There were significant (P < 0.05) trends in decreasing bone volume, trabecular number, and connectivity, and increasing trabecular separation with greater vertebral fracture severity. Histomorphometric bone volume was 25 and 36% lower (P < 0.05) in women with moderate and severe fractures than in women with no fractures, respectively. Compared with women without fractures, women with mild, moderate, and severe fractures had lower (P < 0.05) microCT bone volume (23, 30, and 51%, respectively).

Conclusions

Microarchitectural deterioration was progressively worse in women with increasing severity of vertebral fractures. We conclude that assessment of vertebral fracture severity is an important clinical tool to evaluate the severity of postmenopausal osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

  2. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  3. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  PubMed  CAS  Google Scholar 

  4. Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68

    Article  PubMed  CAS  Google Scholar 

  5. Burger H, Van Daele PL, Algra D, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1994) Vertebral deformities as predictors of non-vertebral fractures. BMJ 309:991–992

    PubMed  CAS  Google Scholar 

  6. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, de Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  PubMed  CAS  Google Scholar 

  7. Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221

    Article  PubMed  Google Scholar 

  8. Siris E, Adachi JD, Lu Y, Fuerst T, Crans GG, Wong M, Harper KD, Genant HK (2002) Effects of raloxifene on fracture severity in postmenopausal women with osteoporosis: results from the MORE study. Multiple Outcomes of Raloxifene Evaluation. Osteoporos Int 13:907–913

    Article  PubMed  CAS  Google Scholar 

  9. Kanis JA, Johnell O, de Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    Article  PubMed  CAS  Google Scholar 

  10. Gallagher JC, Genant HK, Crans GG, Vargas SJ, Krege JH (2005) Teriparatide reduces the fracture risk associated with increasing number and severity of osteoporotic fractures. J Clin Endocrinol Metab 90:1583–1587

    Article  PubMed  CAS  Google Scholar 

  11. Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  12. Lindsay R, Pack S, Li Z (2005) Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int 16:306–312

    Article  PubMed  Google Scholar 

  13. NIH Consensus Development Panel (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795

    Article  Google Scholar 

  14. Kleerekoper M, Villanueva AR, Stanciu J, Rao DS, Parfitt AM (1985) The role of three-dimensional trabecular microstructure in the pathogenesis of vertebral compression fractures. Calcif Tissue Int 37:594–597

    Article  PubMed  CAS  Google Scholar 

  15. Thomsen JS, Ebbesen EN, Mosekilde L (2002) Predicting human vertebral bone strength by vertebral static histomorphometry. Bone 30:502–508

    Article  PubMed  CAS  Google Scholar 

  16. Kimmel DB, Recker RR, Gallagher JC, Vaswani AS, Aloia JF (1990) A comparison of iliac bone histomorphometric data in post-menopausal osteoporotic and normal subjects. Bone Miner 11:217–235

    Article  PubMed  CAS  Google Scholar 

  17. Parfitt AM, Mathews CH, Villanueva AR, Kleerekoper M, Frame B, Rao DS (1983) Relationships between surface, volume, and thickness of iliac trabecular bone in aging and in osteoporosis. Implications for the microanatomic and cellular mechanisms of bone loss. J Clin Invest 72:1396–1409

    Article  PubMed  CAS  Google Scholar 

  18. Hordon LD, Raisi M, Aaron JE, Paxton SK, Beneton M, Kanis JA (2000) Trabecular architecture in women and men of similar bone mass with and without vertebral fracture: I. Two-dimensional histology. Bone 27:271–276

    Article  PubMed  CAS  Google Scholar 

  19. Aaron JE, Shore PA, Shore RC, Beneton M, Kanis JA (2000) Trabecular architecture in women and men of similar bone mass with and without vertebral fracture: II. Three-dimensional histology. Bone 27:277–282

    Article  PubMed  CAS  Google Scholar 

  20. Legrand E, Chappard D, Pascaretti C, Duquenne M, Krebs S, Rohmer V, Basle MF, Audran M (2000) Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res 15:13–19

    Article  PubMed  CAS  Google Scholar 

  21. Oleksik A, Ott SM, Vedi S, Bravenboer N, Compston J, Lips P (2000) Bone structure in patients with low bone mineral density with or without vertebral fractures. J Bone Miner Res 15:1368–1375

    Article  PubMed  CAS  Google Scholar 

  22. Recker RR (1993) Architecture and vertebral fracture. Calcif Tissue Int 53 Suppl 1:S139–S142

    Article  PubMed  Google Scholar 

  23. Wehrli FW, Saha PK, Gomberg BR, Song HK, Snyder PJ, Benito M, Wright A, Weening R (2002) Role of magnetic resonance for assessing structure and function of trabecular bone. Top Magn Reson Imaging 13:335–355

    Article  PubMed  Google Scholar 

  24. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    PubMed  CAS  Google Scholar 

  25. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645

    Article  PubMed  CAS  Google Scholar 

  26. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    Article  PubMed  CAS  Google Scholar 

  27. Ott SM, Oleksik A, Lu Y, Harper K, Lips P (2002) Bone histomorphometric and biochemical marker results of a 2-year placebo-controlled trial of raloxifene in postmenopausal women. J Bone Miner Res 17:341–348

    Article  PubMed  CAS  Google Scholar 

  28. Jiang Y, Zhao JJ, Mitlak BH, Wang O, Genant HK, Eriksen EF (2003) Teriparatide [recombinant human parathyroid hormone (1-34)] improves both cortical and cancellous bone structure. J Bone Miner Res 18:1932–1941

    Article  PubMed  CAS  Google Scholar 

  29. Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 11:984–996

    PubMed  CAS  Google Scholar 

  30. Parfitt AM, Drezner MK, Glorieux FH, Kanis JA, Malluche H, Meunier PJ, Ott SM, Recker RR (1987) Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR histomorphometry nomenclature committee. J Bone Miner Res 2:595–610

    Article  PubMed  CAS  Google Scholar 

  31. Parfitt AM (1984) Age-related structural changes in trabecular and cortical bone: cellular mechanisms and biomechanical consequences. Calcif Tissue Int 36 Suppl 1:S123–S128

    Article  PubMed  Google Scholar 

  32. Wehrli FW, Hilaire L, Fernandez-Seara M, Gomberg BR, Song HK, Zemel B, Loh L, Snyder PJ (2002) Quantitative magnetic resonance imaging in the calcaneus and femur of women with varying degrees of osteopenia and vertebral deformity status. J Bone Miner Res 17:2265–2273

    Article  PubMed  Google Scholar 

  33. Fazzalari NL, Parkinson IH (1998) Fractal properties of cancellous bone of the iliac crest in vertebral crush fracture. Bone 23:53–57

    Article  PubMed  CAS  Google Scholar 

  34. Qiu S, Rao DS, Palnitkar S, Parfitt AM (2003) Reduced iliac cancellous osteocyte density in patients with osteoporotic vertebral fracture. J Bone Miner Res 18:1657–1663

    Article  PubMed  Google Scholar 

  35. Dempster DW, Ferguson-Pell MW, Mellish RW, Cochran GV, Xie F, Fey C, Horbert W, Parisien M, Lindsay R (1993) Relationships between bone structure in the iliac crest and bone structure and strength in the lumbar spine. Osteoporos Int 3:90–96

    Article  PubMed  CAS  Google Scholar 

  36. Mosekilde L, Mosekilde L (1986) Normal vertebral body size and compressive strength: relations to age and to vertebral and iliac trabecular bone compressive strength. Bone 7:207–212

    Article  PubMed  CAS  Google Scholar 

  37. Johnston CC Jr, Bjarnason NH, Cohen FJ, Shah A, Lindsay R, Mitlak BH, Huster W, Draper MW, Harper KD, Heath H, III, Gennari C, Christiansen C, Arnaud CD, Delmas PD (2000) Long-term effects of raloxifene on bone mineral density, bone turnover, and serum lipid levels in early postmenopausal women: three-year data from 2 double-blind, randomized, placebo-controlled trials. Arch Intern Med 160:3444–3450

    Article  PubMed  CAS  Google Scholar 

  38. Parkinson IH, Fazzalari NL (2003) Interrelationships between structural parameters of cancellous bone reveal accelerated structural change at low bone volume. J Bone Miner Res 18:2200–2205

    Article  PubMed  Google Scholar 

  39. Aaron JE, Makins NB, Sagreiya K (1987) The microanatomy of trabecular bone loss in normal aging men and women. Clin Orthop Relat Res 260–271

  40. Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, Peterson JM, Melton LJ III (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res 21:124–131

    Article  PubMed  Google Scholar 

  41. Pistoia W, van Rietbergen B, Lochmuller EM, Lill CA, Eckstein F, Ruegsegger P (2002) Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone 30:842–848

    Article  PubMed  CAS  Google Scholar 

  42. Ito M, Ikeda K, Nishiguchi M, Shindo H, Uetani M, Hosoi T, Orimo H (2005) Multi-detector row CT imaging of vertebral microstructure for evaluation of fracture risk. J Bone Miner Res 20:1828–1836

    Article  PubMed  Google Scholar 

  43. Boutroy S, Bouxsein ML, Munoz F, Delmas PD (2005) In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab

  44. Wehrli FW, Gomberg BR, Saha PK, Song HK, Hwang SN, Snyder PJ (2001) Digital topological analysis of in vivo magnetic resonance microimages of trabecular bone reveals structural implications of osteoporosis. J Bone Miner Res 16:1520–1531

    Article  PubMed  CAS  Google Scholar 

  45. Niebur GL, Feldstein MJ, Yuen JC, Chen TJ, Keaveny TM (2000) High-resolution finite-element models with tissue strength asymmetry accurately predict failure of trabecular bone. J Biomech 33:1575–1583

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Melinda Rance for preparation of the figures. Funding for this work was provided by Eli Lilly and Company.

Author information

Author notes

  1. Y. Jiang

    Present address: Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109-0326, USA

  2. E. F. Eriksen

    Present address: ABH TA Novartis Pharma AG, Postfach, 4002, Basel, Switzerland

  3. J. San Martin

    Present address: Bone Therapeutic Area A, One Amgen Center Drive 27-5-A, Thousand Oaks, CA, 91320, USA

Authors and Affiliations

  1. Department of Radiology, University of California, 533 Parnassus Avenue, Suite U368E, San Francisco, CA, 94143-1250, USA

    H. K. Genant & Y. Jiang

  2. Synarc, Inc., San Francisco, CA, USA

    H. K. Genant

  3. Université Claude Bernard Lyon 1, INSERM Research Unit 403, Lyon, France

    P. D. Delmas

  4. Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA

    P. Chen, E. F. Eriksen, G. P. Dalsky, R. Marcus & J. San Martin

Authors
  1. H. K. Genant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. D. Delmas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. F. Eriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. P. Dalsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Marcus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. San Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. K. Genant.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genant, H.K., Delmas, P.D., Chen, P. et al. Severity of vertebral fracture reflects deterioration of bone microarchitecture. Osteoporos Int 18, 69–76 (2007). https://doi.org/10.1007/s00198-006-0199-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-006-0199-6

Keywords

Search

Navigation