[Insufficiency Fractures of the Spine in Relation to Cancellous Bone Density : An in Vitro Study]

Overview

Journal Orthopadie (Heidelb)

Specialty Orthopedics

Date 2022 Jul 1

PMID 35776151

Authors

Guido Schroder

Dirk Flachsmeyer

Claus Maximilian Kullen

Julian Ramin Andresen

Marko Schulze

Laura Hiepe

Hans-Christof Schober

Reimer Andresen

Affiliations

Soon will be listed here.

Abstract

Background: The risk of osteoporotic insufficiency fractures (Fx) at the axial skeleton increases with decreasing bone density, with an accumulation in the thoracic and thoracolumbar regions. To better understand the differential distribution of Fx along the spine, morphological and osteodensitometric studies were performed by computed tomography (CT) in the various spine sections. In addition, we aimed to clarify whether Hounsfield units (HU) found on CT examinations from other indications correlate with bone density and could be grounds for osteologic diagnosis.

Material And Methods: The entire spines of 26 body donors were fixed in a Plexiglas water phantom and analyzed by high-resolution spiral CT. In addition, CT morphological cancellous bone density was measured in HU from C3 to S2 (624 vertebral bodies). Bone mineral density (BMD, mg/ml) was calculated and used to estimate osteoporosis (OPO).

Results: OPO was present in all spines. Significantly increased sintering fractures were found in the thoracic and thoracolumbar regions when BMD was below 60 mg/ml. Fx in the cervical spine area were not found overall. Cancellous bone density was significantly higher in the cervical (median 188.6 HU) than in the lumbar (median 63.6 HU) and sacral (median 25.5 HU) spine.

Discussion: BMD loss of vertebral body cancellous bone leads to an increased risk of Fx, which is also found in the cadaver spines. However, an apparent threshold for the occurrence of sintering fractures is not undercut in the cervical region. Finding a threshold for HU would be relevant to clinical practice.

Citing Articles

Opportunistic Osteoporosis Assessment and Fracture Risk Determination Using Cancellous Density Measurement in Hounsfield Units of Native Lumbar Computed Tomography Images-A Comparative Study with Conventional Bone Density Evaluation.

Andresen J, Schroder G, Haider T, Andresen R J Clin Med. 2025; 14(4).

PMID: 40004756 PMC: 11856453. DOI: 10.3390/jcm14041226.

Evaluation of Cancellous Bone Density from C3 to L5 in 11 Body Donors: CT Versus Micro-CT Measurements.

Schroder G, Akl E, Hillebrand J, Gotz A, Mittlmeier T, Falk S J Clin Med. 2025; 14(4).

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[Comparative evaluation of trabecular bone density in Hounsfield units in the lumbar native CT cross-section for osteoporosis diagnosis and fracture risk determination by different examiners].

Andresen J, Schroder G, Haider T, Kopetsch C, Kullen C, Schober H Orthopadie (Heidelb). 2024; 54(1):48-60.

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Biomechanical Analysis of Diffuse Idiopathic Skeletal Hyperostosis and Osteoporosis: Vertebral Fracture Risk Evaluation Using Finite Element Modeling with Clinical and Micro-CT Data in an Elderly Donor.

Schroder G, Mittlmeier T, Falk S, Gotz A, Kruse J, Akl E Biomedicines. 2024; 12(11).

PMID: 39595062 PMC: 11592239. DOI: 10.3390/biomedicines12112496.

Interobserver variability in the determination of bone mineral density in Hounsfield units from differently configured fields of measurement in the cancellous bone of vertebral bodies from elderly body donors.

Schroder G, Andresen J, Hiepe L, Schulze M, Kullen C, Kopetsch C J Orthop. 2023; 49:48-55.

PMID: 38075457 PMC: 10698493. DOI: 10.1016/j.jor.2023.11.061.

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