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Vertebral fractures in the elderly may not always be “osteoporotic”

Abstract Introduction Vertebral fractures in the elderly are often assumed to be “osteoporotic” and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiogr...

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Published in:Bone (New York, N.Y.) N.Y.), 2010-07, Vol.47 (1), p.111-116
Main Authors: Jiang, G, Luo, J, Pollintine, P, Dolan, P, Adams, M.A, Eastell, R
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creator Jiang, G
Luo, J
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description Abstract Introduction Vertebral fractures in the elderly are often assumed to be “osteoporotic” and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between “osteoporotic” fractures of vertebrae with low BMD and strength, and “traumatic” fractures of vertebrae with normal BMD and strength. Methods 73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3 mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4 mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA). Results Failure load was proportional to BMD ( R = 0.63, p < 0.001). “Osteoporotic,” “traumatic” and “no discernible” fractures were reported in 16, 26 and 31 specimens respectively. “Traumatic” fracture specimens had higher BMD and failed at higher loads than “osteoporotic” fracture specimens ( p < 0.05). Conclusions Some vertebral fractures in the elderly may be traumatic rather than osteoporotic in origin. Our radiological criteria help to differentiate between them.
doi_str_mv 10.1016/j.bone.2010.03.019
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However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between “osteoporotic” fractures of vertebrae with low BMD and strength, and “traumatic” fractures of vertebrae with normal BMD and strength. Methods 73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3 mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4 mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA). Results Failure load was proportional to BMD ( R = 0.63, p &lt; 0.001). “Osteoporotic,” “traumatic” and “no discernible” fractures were reported in 16, 26 and 31 specimens respectively. “Traumatic” fracture specimens had higher BMD and failed at higher loads than “osteoporotic” fracture specimens ( p &lt; 0.05). Conclusions Some vertebral fractures in the elderly may be traumatic rather than osteoporotic in origin. Our radiological criteria help to differentiate between them.</description><identifier>ISSN: 8756-3282</identifier><identifier>EISSN: 1873-2763</identifier><identifier>DOI: 10.1016/j.bone.2010.03.019</identifier><identifier>PMID: 20362704</identifier><language>eng</language><publisher>Amsterdam: Elsevier</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Bone Density - physiology ; Diagnosis, Differential ; Diseases of the osteoarticular system ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Injuries of the limb. Injuries of the spine ; Male ; Medical sciences ; Middle Aged ; Orthopedics ; Osteoporosis - diagnostic imaging ; Osteoporosis - physiopathology ; Osteoporosis. Osteomalacia. Paget disease ; Radiography ; Spinal Fractures - diagnostic imaging ; Spinal Fractures - physiopathology ; Spine - diagnostic imaging ; Spine - pathology ; Spine - physiopathology ; Traumas. Diseases due to physical agents ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Weight-Bearing - physiology</subject><ispartof>Bone (New York, N.Y.), 2010-07, Vol.47 (1), p.111-116</ispartof><rights>Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-4470c5b52d8be261e1ee7955a4dd6e6530176f8aa0a0e6ecd395b6f2f38e0f163</citedby><cites>FETCH-LOGICAL-c419t-4470c5b52d8be261e1ee7955a4dd6e6530176f8aa0a0e6ecd395b6f2f38e0f163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22956630$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20362704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jiang, G</creatorcontrib><creatorcontrib>Luo, J</creatorcontrib><creatorcontrib>Pollintine, P</creatorcontrib><creatorcontrib>Dolan, P</creatorcontrib><creatorcontrib>Adams, M.A</creatorcontrib><creatorcontrib>Eastell, R</creatorcontrib><title>Vertebral fractures in the elderly may not always be “osteoporotic”</title><title>Bone (New York, N.Y.)</title><addtitle>Bone</addtitle><description>Abstract Introduction Vertebral fractures in the elderly are often assumed to be “osteoporotic” and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between “osteoporotic” fractures of vertebrae with low BMD and strength, and “traumatic” fractures of vertebrae with normal BMD and strength. Methods 73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3 mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4 mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA). Results Failure load was proportional to BMD ( R = 0.63, p &lt; 0.001). “Osteoporotic,” “traumatic” and “no discernible” fractures were reported in 16, 26 and 31 specimens respectively. “Traumatic” fracture specimens had higher BMD and failed at higher loads than “osteoporotic” fracture specimens ( p &lt; 0.05). Conclusions Some vertebral fractures in the elderly may be traumatic rather than osteoporotic in origin. Our radiological criteria help to differentiate between them.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Bone Density - physiology</subject><subject>Diagnosis, Differential</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteoporosis - diagnostic imaging</subject><subject>Osteoporosis - physiopathology</subject><subject>Osteoporosis. Osteomalacia. Paget disease</subject><subject>Radiography</subject><subject>Spinal Fractures - diagnostic imaging</subject><subject>Spinal Fractures - physiopathology</subject><subject>Spine - diagnostic imaging</subject><subject>Spine - pathology</subject><subject>Spine - physiopathology</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Weight-Bearing - physiology</subject><issn>8756-3282</issn><issn>1873-2763</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqFkc9u1DAQhy0EotvCC3BAuSBOWcae2E4uSKiCglSJA3-uluNMRBZvvNhJUW59EPpyfRIc7QJHTiONvt9o9P0Ye8Zhy4GrV7ttG0baCsgLwC3w5gHb8FpjKbTCh2xTa6lKFLU4Y-cp7QAAG80fszMBqISGasOuvlKcqI3WF320bpojpWIYi-kbFeQ7in4p9nYpxjAV1v-0SypaKu5vf4U0UTiEGKbB3d_ePWGPeusTPT3NC_bl3dvPl-_L649XHy7fXJeu4s1UVpUGJ1spuroloThxIt1IaauuU6QkAteqr60FC6TIddjIVvWix5qg5wov2Mvj3UMMP2ZKk9kPyZH3dqQwJ6Nlg6CFqP9PIlaQ_8FMiiPpYkgpUm8OcdjbuBgOZjVtdmY1bVbTBtBk0zn0_HR-bvfU_Y38UZuBFyfAJmd9tju6If3jRCOVQsjc6yNHWdvNQNE4P4xDjnynhdIuzHHMRg03SRgwn9ZS1055rlMi1vgbDTGd4A</recordid><startdate>20100701</startdate><enddate>20100701</enddate><creator>Jiang, G</creator><creator>Luo, J</creator><creator>Pollintine, P</creator><creator>Dolan, P</creator><creator>Adams, M.A</creator><creator>Eastell, R</creator><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QP</scope></search><sort><creationdate>20100701</creationdate><title>Vertebral fractures in the elderly may not always be “osteoporotic”</title><author>Jiang, G ; Luo, J ; Pollintine, P ; Dolan, P ; Adams, M.A ; Eastell, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-4470c5b52d8be261e1ee7955a4dd6e6530176f8aa0a0e6ecd395b6f2f38e0f163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Bone Density - physiology</topic><topic>Diagnosis, Differential</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteoporosis - diagnostic imaging</topic><topic>Osteoporosis - physiopathology</topic><topic>Osteoporosis. Osteomalacia. Paget disease</topic><topic>Radiography</topic><topic>Spinal Fractures - diagnostic imaging</topic><topic>Spinal Fractures - physiopathology</topic><topic>Spine - diagnostic imaging</topic><topic>Spine - pathology</topic><topic>Spine - physiopathology</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Weight-Bearing - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jiang, G</creatorcontrib><creatorcontrib>Luo, J</creatorcontrib><creatorcontrib>Pollintine, P</creatorcontrib><creatorcontrib>Dolan, P</creatorcontrib><creatorcontrib>Adams, M.A</creatorcontrib><creatorcontrib>Eastell, R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><jtitle>Bone (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jiang, G</au><au>Luo, J</au><au>Pollintine, P</au><au>Dolan, P</au><au>Adams, M.A</au><au>Eastell, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vertebral fractures in the elderly may not always be “osteoporotic”</atitle><jtitle>Bone (New York, N.Y.)</jtitle><addtitle>Bone</addtitle><date>2010-07-01</date><risdate>2010</risdate><volume>47</volume><issue>1</issue><spage>111</spage><epage>116</epage><pages>111-116</pages><issn>8756-3282</issn><eissn>1873-2763</eissn><abstract>Abstract Introduction Vertebral fractures in the elderly are often assumed to be “osteoporotic” and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between “osteoporotic” fractures of vertebrae with low BMD and strength, and “traumatic” fractures of vertebrae with normal BMD and strength. Methods 73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3 mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4 mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA). Results Failure load was proportional to BMD ( R = 0.63, p &lt; 0.001). “Osteoporotic,” “traumatic” and “no discernible” fractures were reported in 16, 26 and 31 specimens respectively. “Traumatic” fracture specimens had higher BMD and failed at higher loads than “osteoporotic” fracture specimens ( p &lt; 0.05). Conclusions Some vertebral fractures in the elderly may be traumatic rather than osteoporotic in origin. Our radiological criteria help to differentiate between them.</abstract><cop>Amsterdam</cop><pub>Elsevier</pub><pmid>20362704</pmid><doi>10.1016/j.bone.2010.03.019</doi><tpages>6</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Biological and medical sciences
Bone Density - physiology
Diagnosis, Differential
Diseases of the osteoarticular system
Female
Fundamental and applied biological sciences. Psychology
Humans
Injuries of the limb. Injuries of the spine
Male
Medical sciences
Middle Aged
Orthopedics
Osteoporosis - diagnostic imaging
Osteoporosis - physiopathology
Osteoporosis. Osteomalacia. Paget disease
Radiography
Spinal Fractures - diagnostic imaging
Spinal Fractures - physiopathology
Spine - diagnostic imaging
Spine - pathology
Spine - physiopathology
Traumas. Diseases due to physical agents
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Weight-Bearing - physiology
title Vertebral fractures in the elderly may not always be “osteoporotic”
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