Lumbar trabecular bone mineral density distribution in patients with and without vertebral fractures: A case-control study

Hugo Giambini, Reza Salman Roghani, Andrew R. Thoreson, L. Joseph Melton, Kai Nan An, Ralph E. Gay

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: The proportion of load transmitted through the lumbar neural arch increases with aging, spinal degeneration, and lordosis, effectively shielding the lumbar vertebral bodies from load. This stress shielding may contribute to bone loss in the vertebral body, leading to increased fracture risk. To test his hypothesis, we performed a study to determine if vertebral body fractures were associated with a higher neural arch/vertebral body volumetric bone mineral density (vBMD) ratio. Methods: Trabecular vBMD was calculated by quantitative CT in the L3 vertebral body and neural arch (pars interarticularis) of 36 women with vertebral compression fractures and 39 controls. Neural arch/vertebral body vBMD ratio was calculated, and its relationship to fracture status was determined using linear regression models adjusted for age and body mass index. Results: Vertebral body trabecular vBMD was lower in fracture cases as compared to controls (mean ± SD, 49.0 ± 36.0 vs. 87.5 ± 36.8 mg/cm3, respectively; P < 0.001), whereas trabecular vBMD of the neural arch was similar (96.1 ± 57.6 in cases vs. 118.2 ± 57.4 mg/cm3 in controls; P = 0.182). The neural arch/vertebral body vBMD ratio was significantly greater in the fracture group than in controls (2.31 ± 1.07 vs. 1.44 ± 0.57, respectively; P < 0.001). Conclusion: These results support the hypothesis that stress shielding is a contributor to vertebral body bone loss and may increase fracture risk. Although further studies are needed, there may be a role for interventions that can shift vertebral loading in the spine to help prevent fracture.

Original languageEnglish (US)
Pages (from-to)1346-1353
Number of pages8
JournalEuropean Spine Journal
Issue number6
StatePublished - Jun 2014


  • Bone mineral density
  • Osteoporosis
  • Quantitative computed tomography
  • Risk
  • Spinal fractures

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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