A review of anatomical and mechanical factors affecting vertebral body integrity

Background: The aetiology of osteoporotic vertebral fracture is multifactorial and may be conceptualised using a systems framework. Previous studies have established several correlates of vertebral fracture including reduced vertebral cross-sectional area, weakness in back extensor muscles, reduced bone mineral density, increasing age, worsening kyphosis and recent vertebral fracture. Alterations in these physical characteristics may influence biomechanical loads and neuromuscular control of the trunk and contribute to changes in subregional bone mineral density of the vertebral bodies. Methods: This review discusses factors that have received less attention in the literature, which may contribute to the development of vertebral fracture. A literature review was conducted using electronic databases including Medline, Cinahl and ISI Web of Science to examine the potential contribution of trabecular architecture, subregional bone mineral density, vertebral geometry, muscle force, muscle strength, neuromuscular control and intervertebral disc integrity to the aetiology of osteoporotic vertebral fracture. Interpretation: A better understanding of factors such as biomechanical loading and neuromuscular control of the trunk may help to explain the high incidence of subsequent vertebral fracture after sustaining an initial vertebral fracture. Consideration of these issues may be important in the development of prevention and management strategies.

[1]  W S Marras,et al.  The Effects of Preview and Task Symmetry on Trunk Muscle Response to Sudden Loading , 1989, Human factors.

[2]  H. Wahner,et al.  Site-specificity of bone mineral density and muscle strength in women: job-related physical activity. , 1998, American journal of physical medicine & rehabilitation.

[3]  W C Hayes,et al.  Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. , 1991, Radiologic clinics of North America.

[4]  Claus Christiansen,et al.  Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. , 1994, World Health Organization technical report series.

[5]  G. Vanderstraeten,et al.  CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects , 2000, European Spine Journal.

[6]  P. Dolan,et al.  The relationship between EMG activity and extensor moment generation in the erector spinae muscles during bending and lifting activities. , 1993, Journal of biomechanics.

[7]  Intramuscular Pressure in the Erector Spinae and Intra‐abdominal Pressure Related to Posture and Load , 1998, Spine.

[8]  A Thorstensson,et al.  Erector spinae lever arm length variations with changes in spinal curvature. , 1994, Spine.

[9]  E. Myers,et al.  Biomechanics of osteoporosis and vertebral fracture. , 1997, Spine.

[10]  K. Singer,et al.  The relationship between bone mineral density, vertebral body shape and spinal curvature in the elderly thoracolumbar spine: an in vitro study. , 1994, The British journal of radiology.

[11]  Michael Hahn,et al.  Architecture and distribution of cancellous bone yield vertebral fracture clues , 1996, Archives of Orthopaedic and Trauma Surgery.

[12]  T M Keaveny,et al.  Biomechanical consequences of an isolated overload on the human vertebral body , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  Tadeusz J. Janik,et al.  Prediction of Osteoporotic Spinal Deformity , 2003, Spine.

[14]  Robert G. Miller.  The Effects of Aging Upon Nerve and Muscle Function and Their Importance for Neurorehabilitation , 1995 .

[15]  T. Keaveny,et al.  Relative roles of microdamage and microfracture in the mechanical behavior of trabecular bone , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  E Schneider,et al.  Structure and Function of Vertebral Trabecular Bone , 1997, Spine.

[17]  J. Tsauo,et al.  Spinal Performance and Functional Impairment in Postmenopausal Women with Osteoporosis and Osteopenia without Vertebral Fracture , 2001, Osteoporosis International.

[18]  Phillip Pollintine,et al.  Neural arch load-bearing can weaken the anterior vertebral body and predispose to osteoporotic fracture , 2002 .

[19]  Richard Eastell,et al.  Erratum: 1991 Classification of vertebral fractures (J Bone Miner Res 6:207-215) , 1991 .

[20]  D. Felsenberg,et al.  Comments on the Hypotheses Underlying Fracture Risk Assessment in Osteoporosis as Proposed by the World Health Organization , 1999, Calcified Tissue International.

[21]  A. Leblanc,et al.  Regional Variation in Vertebral Bone Density and Trabecular Architecture Are Influenced by Osteoarthritic Change and Osteoporosis , 1997, Spine.

[22]  J Dequeker,et al.  Incidence of Vertebral Fracture in Europe: Results From the European Prospective Osteoporosis Study (EPOS) , 2002, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[23]  D. Sedlock,et al.  Kyphosis in active and sedentary postmenopausal women. , 2001, Medicine and science in sports and exercise.

[24]  C. Turner,et al.  The Biomechanical Basis of Vertebral Body Fragility in Men and Women , 2001, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[25]  M. Jayson,et al.  Gender variation of human spinal and paraspinal structures. , 1992, Clinical biomechanics.

[26]  Tadeusz J. Janik,et al.  Do Alterations in Vertebral and Disc Dimensions Affect an Elliptical Model of Thoracic Kyphosis? , 2003, Spine.

[27]  Patricia A. Deuster,et al.  Exercise Physiology: Energy, Nutrition and Human Performance , 1991 .

[28]  H Weinans,et al.  Osteoporosis Changes the Amount of Vertebral Trabecular Bone at Risk of Fracture but Not the Vertebral Load Distribution , 2001, Spine.

[29]  K. Singer,et al.  Ex vivo estimation of thoracolumbar vertebral body compressive strength: The relative contributions of bone densitometry and vertebral morphometry , 2005, Osteoporosis International.

[30]  S A Goldstein,et al.  Static and fatigue failure properties of thoracic and lumbar vertebral bodies and their relation to regional density. , 1990, Journal of biomechanics.

[31]  D M Buchner,et al.  Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. , 1999, Age and ageing.

[32]  K. Faulkner,et al.  Future methods in the assessment of bone mass and structure. , 2001, Baillière's Best Practice & Research : Clinical Rheumatology.

[33]  P. Kannus,et al.  Estimation of various mechanical characteristics of human bones using dual energy X-ray absorptiometry: methodology and precision. , 1996, Bone.

[34]  C. Cooper,et al.  Incidence of clinically diagnosed vertebral fractures: A population‐based study in rochester, minnesota, 1985‐1989 , 1992, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[35]  A. Thorstensson,et al.  Preparatory trunk motion accompanies rapid upper limb movement , 1999, Experimental Brain Research.

[36]  R. Eastell,et al.  Classification of vertebral fractures , 1991, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[37]  B. Manthey,et al.  Intervertebral Disc Disorganization Is Related to Trabecular Bone Architecture in the Lumbar Spine , 2001, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[38]  N. Fazzalari,et al.  Intervertebral disc disorganisation and its relationship to age adjusted vertebral body morphometry and vertebral bone architecture , 2001, The Anatomical record.

[39]  H. Minne,et al.  Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. , 2001, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[40]  Rik Huiskes,et al.  Effects of mechanical forces on maintenance and adaptation of form in trabecular bone , 2000, Nature.

[41]  F W Smith,et al.  Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. , 2000, Clinical radiology.

[42]  Thomas M. Link,et al.  Advanced Imaging of the Macrostructure and Microstructure of Bone , 2004, Hormone Research in Paediatrics.

[43]  R. Eastell,et al.  Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. , 1995, Annals of the rheumatic diseases.

[44]  S. Majumdar,et al.  A review of the recent advances in magnetic resonance imaging in the assessment of osteoporosis , 1995, Osteoporosis International.

[45]  F. Puisieux,et al.  Spinal curvatures and quality of life in women with vertebral fractures secondary to osteoporosis. , 1999, Spine.

[46]  M. Grynpas,et al.  Inhomogeneity of human vertebral cancellous bone: systematic density and structure patterns inside the vertebral body. , 2001, Bone.

[47]  Karen V Richards,et al.  The Effect of Different Standing and Sitting Postures on Trunk Muscle Activity in a Pain-Free Population , 2002, Spine.

[48]  S Gracovetsky,et al.  The Optimum Spine , 1986, Spine.

[49]  P. Dolan,et al.  Sudden and unexpected loading generates high forces on the lumbar spine. , 2000, Spine.

[50]  K. Singer,et al.  Prediction of thoracic and lumbar vertebral body compressive strength: correlations with bone mineral density and vertebral region. , 1995, Bone.

[51]  F. Díez.  Guidelines for the diagnosis of osteoporosis by densitometric methods. , 2002, Journal of manipulative and physiological therapeutics.

[52]  É. Legrand,et al.  Trabecular Bone Microarchitecture, Bone Mineral Density, and Vertebral Fractures in Male Osteoporosis , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[53]  W C Hayes,et al.  Biomechanical considerations of hip and spine fractures in osteoporotic bone. , 1997, Instructional course lectures.

[54]  A. Nachemson.  The Load on Lumbar Disks in Different Positions of the Body , 1966, Clinical orthopaedics and related research.

[55]  D. Cody,et al.  The assessment of vertebral bone macroarchitecture with x-ray computed tomography , 2005, Calcified Tissue International.

[56]  M. Sinaki,et al.  A useful technique for measurement of back strength in osteoporotic and elderly patients. , 1991, Mayo Clinic proceedings.

[57]  H. Imhof,et al.  Imaging of trabecular bone structure in osteoporosis , 1999, European Radiology.

[58]  M. Sinaki,et al.  Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. , 1994, Mayo Clinic proceedings.

[59]  Frank I. Katch,et al.  Exercise Physiology: Energy, Nutrition, and Human Performance , 2006 .

[60]  M. Boechat,et al.  Gender differences in vertebral sizes in adults: biomechanical implications. , 1994, Radiology.

[61]  S. McGill,et al.  Changes in lumbar lordosis modify the role of the extensor muscles. , 2000, Clinical biomechanics.

[62]  L. Dai.  The relationship between vertebral body deformity and disc degeneration in lumbar spine of the senile , 1998, European Spine Journal.

[63]  A. Mannion,et al.  Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences , 1997, Journal of anatomy.

[64]  Frederic Martini,et al.  Fundamentals of Anatomy and Physiology , 1997 .

[65]  W C Hayes,et al.  Load Sharing Between the Shell and Centrum in the Lumbar Vertebral Body , 1997, Spine.

[66]  J. Sayre,et al.  Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures. , 1995, The Journal of clinical investigation.

[67]  C. Richardson,et al.  Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First‐Episode Low Back Pain , 1996, Spine.

[68]  R. Mazess,et al.  Normalization of spine densitometry , 1994, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[69]  A. D. De Smet,et al.  Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. , 1988, Radiology.

[70]  S. Gandevia,et al.  Deep and Superficial Fibers of the Lumbar Multifidus Muscle Are Differentially Active During Voluntary Arm Movements , 2002, Spine.

[71]  Régis Logier,et al.  Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. , 2002, Joint, bone, spine : revue du rhumatisme.

[72]  L. Mosekilde,et al.  Local Differences in Mineral Content in Vertebral Trabecular Bone Measured by Dual-Energy Computed Tomography , 1989, Acta radiologica.

[73]  D B Chaffin,et al.  Muscle lines-of-action affect predicted forces in optimization-based spine muscle modeling. , 1995, Journal of biomechanics.

[74]  B. Lawrence Riggs,et al.  Osteoporosis : etiology, diagnosis, and management , 1988 .

[75]  T Hansson,et al.  In vivo dynamic stiffness of the porcine lumbar spine exposed to cyclic loading: influence of load and degeneration. , 1998, Journal of spinal disorders.

[76]  T. Spector,et al.  Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: The chingford study , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[77]  M. Panjabi.  The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. , 1992, Journal of spinal disorders.

[78]  E Itoi,et al.  Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. , 1996, American journal of physical medicine & rehabilitation.

[79]  S. Cummings,et al.  Correlates of Kyphosis in Older Women , 1997 .

[80]  M. Stokes,et al.  Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. , 1994, Spine.

[81]  C. Cooper,et al.  Health‐Related Quality of Life in Postmenopausal Women With Low BMD With or Without Prevalent Vertebral Fractures , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[82]  A. Collins,et al.  The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. , 2000, Rheumatology.

[83]  P. Wollan,et al.  Can strong back extensors prevent vertebral fractures in women with osteoporosis? , 1996, Mayo Clinic proceedings.

[84]  S. Khosla,et al.  Muscle strength in Osteoporotic versus normal women , 2005, Osteoporosis International.

[85]  P. Hodges,et al.  Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain: A Motor Control Evaluation of Transversus Abdominis , 1996, Spine.

[86]  S. H. Kan,et al.  Epidemiology of vertebral fractures in women. , 1989, American journal of epidemiology.

[87]  A. Parfitt,et al.  Vertebral Bone Mass, Size, and Volumetric Density in Women with Spinal Fractures , 1999, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[88]  Alf Thorstensson,et al.  The mechanics of back-extensor torque production about the lumbar spine. , 2003, Journal of biomechanics.

[89]  P Kurowski,et al.  The Relationship of Degeneration of the Intervertebral Disc to Mechanical Loading Conditions on Lumbar Vertebrae , 1986, Spine.