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Anatomical distribution of vertebral fractures: comparison of pediatric and adult spines

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Abstract

Summary

We compared the distribution of vertebral fractures in adults and children and found that fractures occurred in different locations in the two age groups. This likely relates to the different shape of the immature spine.

Introduction

We hypothesized that the anatomical distribution of vertebral fractures (VF) would be different in children compared to adults.

Methods

We compared the distribution of VF defined using the Genant semi-quantitative method (GSQ method) in adults (N = 221; 545 fractures) and in children early in the course of glucocorticoid therapy (N = 44; 94 fractures).

Results

The average age in the adult cohort was 62.9 years (standard deviation (SD), 13.4 years), 26% was male, the mean lumbar spine Z-score was −1.0 (SD, 1.5), and the corresponding T-score was −2.4 (SD, 1.4). The pediatric cohort median age was 7.7 years (range, 2.1–16.6 years), the mean lumbar spine Z-score was −1.7 (SD, 1.5), 52% was male, and disease categories were acute lymphoblastic leukemia (66%), rheumatological conditions (21%), and nephrotic syndrome (14%). The VF distribution was biphasic in both populations, but the peaks differed in location. In adults, the peaks were at T7/T8 and at T12/L1. In children, the focus was higher in the thoracic spine, at T6/T7, and lower in the lumbar spine, at L1/L2. When children were assessed in two age-defined sub-groups, a biphasic VF distribution was seen in both, but the upward shift of the thoracic focus to T6 was observed only in the older group, with the highest rates of fracture present between ages 7 and 10 years.

Conclusions

These results suggest that the anatomical distribution of VF differs between children and adults, perhaps relating to the different shape of the immature spine, notably the changing ratio of kyphosis to lordosis.

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References

  1. Silva MJ (2007) Biomechanics of osteoporotic fractures. Injury 38S3:S69–S76

    Article  Google Scholar 

  2. Zebaze R, Maalouf G, Maalouf N, Seeman E (2004) Loss of regularity in the curvature of the thoracolumbar spine: a measure of structural failure. J Bone Miner Res 19:1099–1104

    Article  PubMed  Google Scholar 

  3. Legaye J, Duval-Beaupere G (2008) Gravitational forces and sagittal shape of the spine. Clinical estimation of their relations. Int Orthop 32:809–816

    Article  PubMed  CAS  Google Scholar 

  4. Legaye J, Duval-Beaupere G (2005) Sagittal plane alignment of the spine and gravity. A radiological and clinical evaluation. Acta Orthop Belg 71:213–220

    PubMed  Google Scholar 

  5. Cil A, Yazici M, Uzumcugil A et al (2004) The evolution of sagittal segmental alignment of the spine during childhood. Spine 30:93–100

    Google Scholar 

  6. Lunt M, O’Neill TW, Felsenberg D et al (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513

    Article  PubMed  Google Scholar 

  7. Healy JH, Lane JM (1985) Structural scoliosis in osteoporotic women. Clinical Orthop Relat Res 195:216–223

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakcioglu B, Mitlak BH, Delmas PD (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 17:1189–1195

    Article  PubMed  CAS  Google Scholar 

  10. Fechtenbaum J, Cropet C, Kolta S, Verdoncq B, Orcel P, Roux C (2005) Reporting of vertebral fracture on spine X-rays. Osteoporos Int 16:1823–1826

    Article  PubMed  CAS  Google Scholar 

  11. Fuerst T, Wu C, Genant HK et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205

    Article  PubMed  CAS  Google Scholar 

  12. Genant HK, Jergas M, Palermo L et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996

    Article  PubMed  CAS  Google Scholar 

  13. Leidig-Bruckner G, Genant HK, Minne HW et al (1994) Comparison of a semiquantitative and a quantitative method for assessing vertebral fractures in osteoporosis. Osteoporos Int 4:154–161

    Article  PubMed  CAS  Google Scholar 

  14. Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668

    Article  PubMed  CAS  Google Scholar 

  15. Vallarta-Ast N, Krueger D, Wrase C, Agrawal S, Binkley N (2007) An evaluation of densitometric vertebral fracture assessment in men. Osteoporos Int 18:1405–1410

    Article  PubMed  CAS  Google Scholar 

  16. Wu CY, Li J, Jergas M, Genant HK (1995) Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int 5:354–370

    Article  PubMed  CAS  Google Scholar 

  17. Huber AM, Gaboury I, Cabral DA et al (2010) Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders. Arthritis Care Res 62:516–528

    Article  CAS  Google Scholar 

  18. Halton J, Gaboury I, Grant R et al (2009) Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-associated Osteoporosis in the Pediatric Population (STOPP) Research Program. J Bone Miner Res 24:1326–1334

    Article  PubMed  Google Scholar 

  19. Feber J, Gaboury I, Ni A et al (2011) Skeletal findings in children initiating glucocorticoids for the treatment of nephrotic syndrome. Osteoporos Int (in press)

  20. Willner S, Johnson B (1983) Thoracic kyphosis and lumbar lordosis during the growth period in children. Acta Paediatr Scand 72:873–878

    Article  PubMed  CAS  Google Scholar 

  21. Singer KP, Jones TJ, Breidahl PD (1990) A comparison of radiographic and computer-assisted measurements of thoracic and thoracolumbar sagittal curvature. Skeletal Radiol 19:21–26

    Article  PubMed  CAS  Google Scholar 

  22. Nissensen M (1995) Spinal posture during pubertal growth. Acta Paediatr 84:308–312

    Article  Google Scholar 

  23. Siminoski K, Warshawski RS, Jen H, Lee K (2006) The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women. Osteoporos Int 17:290–296

    Article  PubMed  CAS  Google Scholar 

  24. Ogden CL, Kuczmarski RJ, Flegal KM et al (2000) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60

    Article  Google Scholar 

  25. Yuan HA, Brown CW, Phillips FM (2004) Osteoporotic spinal deformity. A biomechanical rationale for the clinical consequences and treatment of vertebral body compression fractures. J Spinal Disord Tech 17:236–242

    Article  PubMed  Google Scholar 

  26. Myers ER, Wilson SE (1997) Biomechanics of osteoporosis and vertebral fracture. Spine 22(Suppl 2):25S–31S

    Article  PubMed  CAS  Google Scholar 

  27. Briggs AM, Greig AM, Wark JD (2007) The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int 18:575–584

    Article  PubMed  CAS  Google Scholar 

  28. Andersson GBJ (1992) Biomechanics of the spine. In: Kirkadldy-Willis WH, Burton CV (eds) Managing low back pain, 3rd edn. Churchill Livingstone, New York, pp 27–37

    Google Scholar 

  29. Davison KS, Siminoski K, Adachi JD et al (2006) Bone strength the whole is greater than the sum of its part. Semin Arthritis Rheum 36:22–31

    Article  PubMed  Google Scholar 

  30. Trout AT, Kallmes DF, Layton KF, Thielen KR, Hentz JG (2006) Vertebral endplate fracture: an indicator of the abnormal forces generated in the spine after vertebroplasty. J Bone Miner Res 21:1797–1802

    Article  PubMed  Google Scholar 

  31. Nakhla M, Scuccimarri R, Duffy KN et al (2009) Prevalence of vertebral fractures in children with chronic rheumatic disease at risk for osteopenia. J Pediatr 154:438–443

    Article  PubMed  Google Scholar 

  32. Varonos S, Ansell BM, Reeve J (1987) Vertebral collapse in juvenile chronic arthritis: its relationship with glucocorticoid therapy. Calcif Tissue Int 41:75–78

    Article  PubMed  CAS  Google Scholar 

  33. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227

    Article  PubMed  CAS  Google Scholar 

  34. Reilly CW (2007) Pediatric spine trauma. J Bone Joint Surg 89-A(Suppl 1):98–107

    Article  Google Scholar 

  35. Hegenbarth R, Ebel KD (1976) Roentgen findings in fractures of the vertebral column in childhood. Pediat Radiol 5:34–39

    Article  PubMed  CAS  Google Scholar 

  36. Leonard M, Sproule J, McCormack D (2007) Paediatric spinal trauma and associated injuries. Injury 38:188–193

    Article  PubMed  CAS  Google Scholar 

  37. Ferrar L, Jiang G, Clowes JA, Peel NF, Eastell R (2008) Comparison of densitometric and radiographic vertebral fracture assessment using the algorithm-based qualitative (ABQ) method in postmenopausal women at low and high risk of fracture. J Bone Miner Res 23:103–111

    Article  PubMed  Google Scholar 

  38. Ismail AA, Cooper C, Falsenberg D et al (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int 9:206–213

    Article  PubMed  CAS  Google Scholar 

  39. Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770

    Article  PubMed  CAS  Google Scholar 

  40. Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and non-vertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  41. Tanko LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920

    Article  PubMed  Google Scholar 

  42. Ferrar L, Jiang G, Cawthon PM et al (2007) Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 22:1434–1441

    Article  PubMed  Google Scholar 

  43. Gaca AM, Barnhart HX, Bisset GS (2010) Evaluation of wedging of lower thoracic and upper lumbar vertebral bodies in the pediatric population. Am J Roentgenol 194:516–520

    Article  Google Scholar 

  44. Goh S, Price RI, Song S, Davis S, Singer KP (2000) Magnetic resonance-based vertebral morphometry of the thoracic spine: age, gender and level-specific influences. Clin Biomech 15:417–425

    Article  CAS  Google Scholar 

  45. Natsui K, Tanaka K, Suda M et al (2006) High-dose glucocorticoid treatment induces rapid loss of trabecular bone mineral density and lean body mass. Osteoporos Int 17:105–108

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The Canadian STOPP Consortium would like to thank the children and their families who participated in the study and without whom the STOPP research program would not have been possible.

STOPP would also like to thank the following:

The research associates who managed the study at the Children’s Hospital of Eastern Ontario: Steve Anderson (project management), Victor Konji (project management), Catherine Riddell (project management), Maya Scharke (data analysis, database management), Elizabeth Sykes (project management), Monica Tomiak (statistical analysis).

The research associates who took care of the patients: Claude Belleville, Ronda Blasco, Erika Bloomfield, Dan Catte, Heather Cosgrove, Susan Docherty-Skippen, Diane Laforte, Maritza Laprise, Josie MacLennan, Natacha Gaulin Marion, Leila MacBean, Amanda Mullins, Michele Petrovic, Eileen Pyra, Mala Ramu, Angelyne Sarmiento, Terry Viczko, and Aleasha Warner.

The research nurses and support staff from the various Divisions of Nephrology, Oncology, Rheumatology and Radiology who have contributed to the care of the children enrolled in the study.

The STeroid-associated Osteoporosis in the Pediatric Population (STOPP) Consortium:

Alberta Children’s Hospital, Calgary, Canada: Reinhard Kloiber, Victor Lewis, Julian Midgley, Paivi Miettunen, David Stephure; British Columbia Children’s Hospital, Vancouver, Canada: David Cabral, David B. Dix, Kristin Houghton, Helen R. Nadel; British Columbia Women’s Hospital and Health Sciences Center, Vancouver, Canada: Brian C. Lentle; Brock University, St. Catharines, Canada: John Hay; Children’s Hospital of Eastern Ontario, Ottawa, Canada: Janusz Feber, Jacqueline Halton, Roman Jurencak, MaryAnn Matzinger, Johannes Roth, Nazih Shenouda, Leanne M. Ward; IWK Health Center, Halifax, Canada: Elizabeth Cummings, Conrad Fernandez, Adam M. Huber, Bianca Lang, Kathy O’Brien; McMaster Children’s Hospital, Hamilton, Canada: Stephanie Atkinson, Steve Arora, Ronald Barr, Craig Coblentz, Peter B. Dent, Maggie Larche, Colin Webber; Montreal Children’s Hospital, Montreal, Canada: Sharon Abish, Lorraine Bell, Celia Rodd, Rosie Scuccimarri; Ottawa Hospital Research Institute, Ottawa, Canada: David Moher, Tim Ramsay; Shriners Hospital for Children, Montreal, Canada: Francis Glorieux, Frank Rauch; Ste. Justine Hospital, Montreal, Canada: Nathalie Alos, Caroline Laverdiere, Josee Dubois, Veronique Phan, Claire Saint-Cyr; Stollery Children’s Hospital, Edmonton, Canada: Robert Couch, Janet Ellsworth, Claire LeBlanc, Maury Pinsk, Kerry Siminoski, Beverly Wilson; Toronto Hospital for Sick Children, Toronto, Canada: Martin Charron, Ronald Grant, Diane Hebert; Universite de Sherbrooke, Sherbrooke, Canada: Isabelle Gaboury; University of Western Ontario, London, Canada: Elizabeth Cairney, Cheril Clarson, Guido Filler, Joanne Grimmer, Keith Sparrow, Robert Stein; Winnipeg Children’s Hospital, Winnipeg, Canada: Tom Blydt-Hansen, Sara Israels, Kiem Oen, Martin Reed, Shayne Taback

Conflicts of interest

H. Nadel received an honorarium from Siemens Canada for speaking at a radiology symposium. None of the other authors have any disclosures.

Funding

The primary funding source of this study was from The Canadian Institutes of Health Research. Additional funding sources were from The Canadian Child Health Clinician Scientist Program, The Children’s Hospital of Eastern Ontario Research Institute, and Women and Children’s Health Research Institute, University of Alberta.

Author information

Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, 6628-123 Street, Edmonton, AB, Canada, T6H 3T6

    K. Siminoski

  2. Department of Radiology, University of Toronto, Toronto, Canada

    M. Charron

  3. Department of Radiology, McMaster University, Hamilton, Canada

    C. Coblentz & C. Webber

  4. Department of Radiology, Universite de Montreal, Montreal, Canada

    J. Dubois

  5. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada

    K.-C. Lee, H. Jen & R. Warshawski

  6. Department of Radiology, University of Calgary, Calgary, Canada

    R. Kloiber

  7. Department of Radiology, University of British Columbia, Vancouver, Canada

    H. Nadel & B. Lentle

  8. Department of Diagnostic Imaging, University of Ottawa, Ottawa, Canada

    M. A. Matzinger & N. Shenouda

  9. Department of Radiology, Dalhousie University, Halifax, Canada

    K. O’Brien

  10. Department of Radiology, University of Manitoba, Winnipeg, Canada

    M. Reed

  11. Department of Radiology, University of Western Ontario, London, Canada

    K. Sparrow

  12. Department of Pediatrics, University of Ottawa, Ottawa, Canada

    L. M. Ward

  13. Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, 6628-123 Street, Edmonton, AB, Canada, T6H 3T6

    K. Siminoski

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  1. K. Siminoski
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  2. K.-C. Lee
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  3. H. Jen
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  9. J. Dubois
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  11. H. Nadel
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STOPP Consortium

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Correspondence to K. Siminoski.

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Siminoski, K., Lee, KC., Jen, H. et al. Anatomical distribution of vertebral fractures: comparison of pediatric and adult spines. Osteoporos Int 23, 1999–2008 (2012). https://doi.org/10.1007/s00198-011-1837-1

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  • DOI: https://doi.org/10.1007/s00198-011-1837-1

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