Vertebral morphometry in women aged 50-81 years

doi:10.1016/S0169-6009(08)80118-3

Bone and Mineral

Volume 21, Issue 1, April 1993, Pages 29-40

https://doi.org/10.1016/S0169-6009(08)80118-3 Get rights and content

Summary

Vertebral dimensions and vertebral shape indices (VSI) were investigated in T4-L4 in 926 females aged 50-81 years. The most consistent finding was the increase of inferior antero-posterior dimension with age. Wedging and concavity also increased with age but the changes were not significant at all vertebral levels. The value of VSIs also varied with level. Thus a particular degree of VSI, considered normal at one level or at one age, would be outside the reference range at a different level or age group. The number of subjects identified as osteoporotic by skewness (5.4%) or in excess of three standard deviations from the mean (6.5%) was much lower than in recent reports from North America. The number of subjects contributing to a skewed distribution increased with age from 0.5% at 55-59 years to 10.0% at 75-79 years. Change with age in the antero-posterior dimension could increase load-bearing area in older subjects, but the decline in bone density will be increased as a declining bone mineral content occupies a larger volume.

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Vertebral fractures are also associated with a loss of height (Tobias et al., 2007); however, women who suffered a vertebral fracture (defined as reduction in vertebral height of >20%), were excluded from our analysis. In cross-sectional studies, decreases in vertebral body height are reported across increasing age groups (Rea et al., 1998; Diacinti et al., 1995; Evans et al., 1993). Conversely, a prospective study over 15–20 years found no change in vertebral dimensions with age (Davies et al., 1989), suggesting that increasing body height across generations may explain some or all of the cross-sectional difference in vertebral height.
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Morphometric points for the measurement of all vertebral dimensions were defined in accordance with pertinent accounts in the literature, making any modifications that may have been necessary to meet our study objective—vertebral area calculation. A number of techniques for the diagnosis of osteoporotic vertebral deformities (21–23) and investigations aimed at defining normal ranges for vertebral body dimensions were based on similar morphometric point coordinates (5,24,25). Based on the study by Nelson et al (19) dealing with the measurement of lateral vertebral areas in adult females, and on our own modifications for vertebral area calculation, we defined 8 morphometric points per vertebral body for measurements on lateral and anteroposterior radiographs (Fig. 1A).
This study reports gender-specific vertebral area gain data from children and adolescents. Vertebral area was measured on lateral and anteroposterior thoracic and lumbar spine radiographs from 100 female and 100 male subjects aged 7–28 yr. T9, T11, T12, L1, and L2 X-ray area calculation was based on calculation of the area of the geometric figure of a trapezoid whose 2 nonparallel sides were equal in length, taking account of the waisted shape of the vertebrae. Both the boys and girls of our study population showed statistically significant dependence (p < 0.001) of vertebral area gain on chronologic age, height, and weight right through the end of puberty, and especially so up to age 15 yr. However, height and weight were clearly better predictors of lateral and anteroposterior vertebral area gain than was chronologic age. Once vertebral growth is complete by age 18 yr or so, the lateral vertebral areas of the male subjects—regardless of body weight and height—are, on average, 25% larger, and the anteroposterior areas up to 30% larger than those of their female counterparts. After adjusting for chronologic age, height, and weight however we did not find significant differences, between gender, in vertebral area of male and female subjects, neither among children younger than 11 yr nor adolescents ages of 12–14 yr and young adults older than 18 yr.
Vertebral morphometry by X-ray absorptiometry: Which reference data for vertebral heights?
2011, Bone
Citation Excerpt :
The prospective studies following women from pre-to post-menopause [25]did not find a significant decrease in vertebral heights and ratios with age. Conversely, all the cross-sectional studies, except the study of Bianco et al., identified significant change in vertebral heights in older women [49,50]. Also the A/P ratio showed a significant decrease with age and the authors concluded that the observed changes could not be due to the cohort effect.
The recent improvement in the resolution of dual-energy X-ray absorptiometry (DXA) images enables most vertebral levels to be seen adequately and thus DXA may be a worthwhile alternative to radiologic morphometry for the identification of vertebral fractures (VF). In this multicenter study, we have derived reference data for vertebral heights and their ratios in Italian women using morphometric X-ray absorptiometry (MXA).
DXA scans were acquired in 1254 consecutive pre- and postmenopausal women, (mean age 63.7 ± 11.3, range 26–88 yrs), referred to six osteoporosis centers. MXA analysis of these images was performed by the same operator measuring vertebral heights and height ratios from L4 to T4. We calculated measures of central tendency and dispersion of vertebral heights and vertebral ratios using different approaches (mean and standard deviation as well as median and interquartile range of raw data, mean and standard deviation of trimmed data using an iterative algorithm, and mean and standard deviation of not fractured vertebrae).
Independently of the approach that we used, all the measures of central tendency were similar, while significant differences were found when compared with reference ranges in other populations. The vertebral heights of our sample at every vertebral level were significantly smaller than both Rea population and the Lunar reference values, even after normalization. Splitting data according to age groups, there was a decrease in the vertebral heights and ratios between the younger and older women.
This study demonstrates that reference data for MXA should be population specific and age matched.
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Various factors in addition to normal aging are reported to be associated with spinal osteoarthritis. The links between the risk factors and osteoarthritis are unclear. This study proposes an analysis of factors associated with spinal osteoarthritis using a collection of cervical and lumbar X-ray images, maintained by the US National Library of Medicine. Five hundred and forty-eight images of adults (60–74 years old, 242 males, 306 females) are analyzed. Six to nine anatomical points are selected by an experienced radiologist on each vertebra. Four dimensionless indexes are calculated: the anterior-to-posterior height ratio (APR), the disc space relative to posterior height of vertebra (DS) and the number of osteophytes. Correlations of these parameters are estimated with three anthropometric indexes: age, gender and body mass index. The univariate relationships are evaluated using one-way analysis of variance and Kruskal-Wallis test. Osteophytes are more frequent for men than for women. Men have lower APR from the levels L1 to L4 and lower DS at the levels C4 and C5. The lumbar levels L2 and L4 are more affected with age by changes in APR. Obese group has a higher DS at the level C3-C4 and a higher APR at the level L1. The analysis of images shows the predominant effect of osteoarthritis at the lower levels of the cervical and lumbar spine.
De nombreux facteurs en plus de la vieillesse normale sont associés à l’ostéoarthrite du rachis. Les liens entre les facteurs de risque et l’ostéoarthrite ne sont pas clairement identifiés et localisés. La présente étude propose une analyse de facteurs anthropométriques associés à l’ostéoarthrite en utilisant une base d’images radiographiques cervicales et lombaires, maintenue par la Librairie nationale de médecine des États-Unis. Cinq cent quarante-huit images de rachis d’adultes (âgés de 60 à 74 ans, 242 masculins, 306 féminins) sont analysées. Six à neuf points anatomiques sont sélectionnés par un radiologiste expérimenté sur chaque vertèbre. Quatre indices sans dimension sont calculés: le rapport de hauteur antéro-postérieur (RAP), l’espace discal rapporté à la hauteur postérieure de la vertèbre (ED) et le nombre d’ostéophytes. Les corrélations de ces paramètres avec trois indices anthropométriques sont estimées : l’âge, le genre et l’indice de masse corporelle. Les relations univariées sont évaluées par une analyse de la variance à un facteur et un test de Kruskal-Wallis. Les ostéophytes sont plus nombreux chez les hommes que chez les femmes. Les hommes ont un RAP plus petit sur les niveaux L1 à L4 et un ED plus petit aux niveaux C4 et C5. Les niveaux lombaires L2 et L4 sont plus affectés par des changements du RAP avec l’âge. Le groupe de patients obèses a un ED plus grand au niveau C3-C4 et un RAP plus grand au niveau L1. L’analyse des images montre l’effet prédominant de l’ostéoarthrite sur les niveaux bas du rachis cervical et lombaire.
Radiology of Osteoporosis
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2006, Bone
Annual changes in vertebral body heights (VHs) and lumbar bone mineral density (LBMD) were evaluated in 120 healthy pre- and post-menopausal women aged 45–74 years. Subjects were divided into groups according to menstrual status and years since menopause (YSM).
Vertebral heights were evaluated, using radiological morphometry as the sum of anterior vertebral body heights (AVHs) from T4 to L5 at baseline and exactly 12 months later.
Results indicate that the sum of VHs is inversely correlated with advancing age, and the decrease in VHs is not a constant process over time but rather exhibits cyclical damping oscillations.
When log-linear trend of VH decrease was transformed into a constant considering annual percentage changes, the presence of a cyclical component of 7 years was evident. Employing a harmonic regression model, the cyclical component was also statistically significant on baseline data. The cyclical decrease of VHs corresponds to an analogous cyclical behavior of LBMD values.
These results suggest that a lack of estrogen acts as a synchronizer on bone remodeling, triggering a latent cyclical rhythm of bone loss, accompanied by cyclical bone microarchitecture deterioration and consequent vertebral body deformities, which after menopause persists throughout life. The existence of a chronobiological rhythm of bone loss and trabecular bone strength reduction at vertebral level after menopause, if confirmed, could have important clinical implications.

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Vertebral morphometry in women aged 50-81 years

Summary

Bone

Vertebral fracture or vertebral deformity

Calcif Tissue Int

A new approach to defining normal vertebral dimensions

J Bone Miner Res

A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis

Bone Miner

Vertebral morphometry: normative data

Bone Miner

A comparison of morphometric definitions of vertebral fracture

J Bone Miner Res

Normal vertebral dimensions and normal variation in serial measurements of vertebrae

J Bone Miner Res