Trabecular structural difference between the superior and inferior regions of the vertebral body: a cadaveric and clinical study

Frontiers in Endocrinology

Endocrinology

Yeonju Lee¹  Tae-Sun Hwang²  Jin-Woo Cho³  Jongbeom Oh³  Wooyeol Ahn³  Younghun Lee³  Jaemin Lee³  Dong Eun Shin³  Hyun-Ju An⁴  Soonchul Lee⁴  Chul Gie Hong⁵ 

[1] CHA Graduate School of Medicine, Pochon, Republic of Korea;Department of Anatomy, School of Medicine, CHA University, Gyeonggi-do, Republic of Korea;Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea;Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea;SL Bio, Inc., Gyeonggi-do, Republic of Korea;Department of Orthopedic Surgery, Kangwon National University Hospital, Gangwon-do, Republic of Korea;

关键词: superior region;    inferior region;    osteoporosis;    compression fracture;    bone mineral density;    vertebrae;   

DOI  :  10.3389/fendo.2023.1238654

 received in 2023-07-03, accepted in 2023-08-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundOsteoporotic vertebral compression fractures commonly involve the superior vertebral body; however, their associated causes have not yet been clearly established. This study aimed to determine the trabecular structural differences between the superior and inferior regions of the vertebral body using cadaveric and clinical studies.Materials and methodsFirst, five vertebrae were collected from three human cadavers. The trabecular structures of the superior and inferior regions of each vertebral body were analyzed using micro-computed tomography (micro-CT), finite element analysis (FEA), and biomechanical test. Based on the results of the ex vivo study, we conducted a clinical study. Second, spine CT images were retrospectively collected. Bone volume and Hounsfield unit were analyzed for 192 vertebral bodies. Finally, after sample size calculation based on the pilot study, prospectively, 200 participants underwent dual-energy X-ray absorptiometry (DXA) of the lateral spine. The bone mineral densities (BMDs) of the superior and inferior regions of each lumbar vertebral body were measured. The paired t-test and Wilcoxon signed-rank test were used for the statistical analyses, and p-value < 0.05 was considered significant.ResultsCadaver studies revealed differences between the superior and inferior trabecular bone structures. The bone volume ratio, BMD, and various other trabecular parameters advocated for decreased strength of the superior region. Throughout the biomechanical study, the limitations of the compression force were 3.44 and 4.63 N/m2 for the superior and inferior regions, respectively. In the FEA study, the inferior region had a lower average displacement and higher von Mises stress than the superior region. In the clinical spine CT-based bone volume and BMD study, the bone volume was significantly higher in the inferior region than in the superior region. In the lateral spine DXA, the mean BMD of the superior region of vertebral bodies was significantly lower compared with that of the inferior region.ConclusionThe superior trabecular structure of the lumbar vertebral bodies possesses more biomechanical susceptibility compared with the inferior trabecular structure, confirming its dominant role in causing osteoporotic vertebral fractures. Physicians should also focus on the BMD values of the superior region of the vertebral body using lateral spine DXA to evaluate osteoporosis.

【 授权许可】

Unknown   
Copyright © 2023 Shin, Lee, An, Hwang, Cho, Oh, Ahn, Lee, Hong, Lee and Lee