Vertebral fractures (VF) are the most common fracture among older persons, afflicting 20-35% of women and 15-25% of men >50 yrs, and leading to profound morbidity, increased mortality, and costs exceeding $1 billion in the US annually. There is strong evidence that factors other than low bone mineral density (BMD) influence VF risk. Yet, the biomechanical factors that contribute to fractures are poorly understood. From a mechanical perspective, a VF occurs when loads applied to the vertebrae exceed its strength. Thus, in this competing renewal, we aim to study several factors that our recent work indicates are related to VF risk, either by affecting vertebral loading and/or vertebral strength. We will build upon our prior cross-sectional findings by studying several novel factors that may contribute to incident vertebral fractures in two, well-characterized cohorts: the Framingham Heart Study Multidetector CT Study and the Age, Gene/Environment Susceptibility- Reykjavik Study (AGES). In the last funding period, we showed that estimates of vertebral loading are highly sensitive to several factors, namely variations in spine curvature, trunk muscle size and trunk muscle density that were not accounted for in our (and others') prior studies and likely led to errors in the in vivo estimates of vertebral loading. Our preliminary data also show that a novel measure of heterogeneity in the distribution of bone density within the vertebral body is associated with vertebral strength in cadaveric specimens and with prevalent VF, even after adjusting for BMD. Thus we propose to conduct a prospective study of incident VF to determine the contribution of 1) spinal curvature, 2) the size and quality of trunk muscles;and 3) the distribution of bone density within the vertebral body to VF. Further, we will test whether a patient-specific factor-of-risk (ie, load-to-strength ratio) that uses state-of-the art approaches to estimate vertebral strength and in vivo spinal loading predicts incident VF better than aBMD or FRAX alone. In summary, this project is significant because it addresses the need to reduce the growing burden of VF. The proposal is highly innovative and efficient by using existing QCT and clinical data from well-characterized prospective population- based cohorts, along with an experienced team and multidisciplinary approach to gain knowledge about the etiology of VF. Completion of the proposed work will ultimately shift the current paradigm for VF etiology "beyond BMD", thereby pointing towards new approaches to identify those at risk for fracture and novel interventions to reduce the occurrence of VF.

Public Health Relevance

The proposed research is relevant to public health because it addresses the mechanisms underlying spine fractures, which are the most common fracture among older adults. The studies will go beyond bone mineral density to determine the contribution of biomechanical factors to age-related deterioration of vertebral strength and fracture. The information will reduce the burden of vertebral fractures by helping clinicians identify and treat those at greatest risk for fracture.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
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Lester, Gayle E
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Beth Israel Deaconess Medical Center
United States
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Anderson, Dennis E; Bean, Jonathan F; Holt, Nicole E et al. (2014) Computed tomography-based muscle attenuation and electrical impedance myography as indicators of trunk muscle strength independent of muscle size in older adults. Am J Phys Med Rehabil 93:553-61
Anderson, D E; Demissie, S; Allaire, B T et al. (2014) The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture. Osteoporos Int 25:559-66
Bruno, Alexander G; Broe, Kerry E; Zhang, Xiaochun et al. (2014) Vertebral size, bone density, and strength in men and women matched for age and areal spine BMD. J Bone Miner Res 29:562-9
Anderson, Dennis E; D'Agostino, John M; Bruno, Alexander G et al. (2013) Variations of CT-based trunk muscle attenuation by age, sex, and specific muscle. J Gerontol A Biol Sci Med Sci 68:317-23
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Samelson, Elizabeth J; Christiansen, Blaine A; Demissie, Serkalem et al. (2012) QCT measures of bone strength at the thoracic and lumbar spine: the Framingham Study. J Bone Miner Res 27:654-63
Dufour, A B; Roberts, B; Broe, K E et al. (2012) The factor-of-risk biomechanical approach predicts hip fracture in men and women: the Framingham Study. Osteoporos Int 23:513-20
Anderson, Dennis E; D'Agostino, John M; Bruno, Alexander G et al. (2012) Regressions for estimating muscle parameters in the thoracic and lumbar trunk for use in musculoskeletal modeling. J Biomech 45:66-75

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