BACKGROUND:Trabecular bone strength diminishes as a result of osteoporosis and altered biomechanical loading at the vertebral and spinal levels. The spine consists of the anterior, middle and posterior columns and the load supported by the anterior and middle columns will differ across different regions of the spine. Stress shielding of the anterior column can contribute to bone loss and increase the risk of wedge fracture. There is a lack of quantitative data related to regional spinal bone mineral density distribution over time. We hypothesize that there is an increase in the posterior-to-anterior vertebral body bone mineral density ratio and a decrease in whole-body bone mineral density over time. METHODS:Bone mineral density was measured in 33 subjects using quantitative computed tomography scans for L1-L3 vertebrae, region (anterior and posterior vertebral body), and time (baseline and 6 years after). FINDINGS:Lumbar bone mineral density decreased significantly (Δ: ~15%) from baseline to the 6th year visit. Individual vertebra differences over time (L1: ~14%, L2: ~14%, L3: ~17%) showed statistical significance. Anterior bone mineral density change was significantly greater than in the posterior vertebral body region (Δ anterior: ~18%; Δ posterior: ~13%). Posterior-to-anterior bone mineral density ratio was significantly greater in the 6th year compared to baseline values (mean (SD), 1.33 (0.2) vs. 1.23 (0.1)). INTERPRETATION:This study provides longitudinal quantitative measurement of bone mineral density in vertebrae as well as regional changes in the anterior and posterior regions. Understanding bone mineral density distribution over time may help to decrease the risk of wedge fractures if interventions can be developed to bring spine loading to its normal state.

译文

背景:由于骨质疏松症以及椎体和脊柱水平的生物力学负荷改变,小梁的骨强度降低。脊柱由前,中和后柱组成,由前柱和中柱支撑的载荷在脊柱的不同区域会有所不同。前柱的应力屏蔽可能会导致骨质流失并增加楔形骨折的风险。缺乏与区域脊柱骨矿物质密度随时间分布有关的定量数据。我们假设随着时间的推移,椎体前后骨矿物质密度比增加,而全身骨矿物质密度降低。
方法:采用定量计算机断层扫描技术对33名受试者的L1-L3椎骨,区域(椎体的前后)和时间(基线及术后6年)进行了骨矿物质密度测量。
结果:从基线到第6年随访,腰椎骨矿物质密度显着降低(Δ:〜15%)。随时间变化的各个椎骨差异(L1:〜14%,L2:〜14%,L3:〜17%)显示出统计学意义。前骨矿物质密度变化显着大于后椎体区域(Δ前:〜18%;Δ后:〜13%)。与基线值相比,第6年的前后骨矿物质密度比显着更高(平均值(SD)为1.33(0.2)对1.23(0.1))。
解释:这项研究提供了纵向定量测量椎骨中骨矿物质密度以及前后区域的变化的信息。如果可以采取干预措施使脊柱负荷恢复到正常状态,那么了解随着时间推移的骨矿物质密度分布可能有助于降低楔形骨折的风险。

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