The Relationship Between the Heterogeneity of Lumbar Vertebral Trabecular Bone Mineral Density Distribution and Osteoporotic Vertebral Fractures.

Abstract

This study aims to investigate the relationship between the spatial distribution and heterogeneity of lumbar vertebral trabecular volumetric bone mineral density (vBMD) and osteoporotic vertebral fractures(OVF). This retrospective study included the L1 and L2 vertebrae of 143 participants with osteoporotic vertebral fractures and 429 age- and sex-matched no-fractured controls. Spatial distribution was assessed using the superior/middle and inferior/middle ratios, while heterogeneity was indicated by the quartile coefficient of variation (QCV) and interquartile range (IQR). We used QCT to measure the integral vBMD of the vertebra and the regional vBMD in the superior, middle, and inferior subregions. QCV and IQR were computed for both integral vertebrae and three subregions using voxel values from CT images. Differences between fracture and control groups were analyzed after stratification by age and sex. T-tests and Wilcoxon rank-sum tests assessed differences in spatial distribution and heterogeneity between fracture and control groups. Conditional logistic regression was employed to evaluate the associations between spatial distribution and heterogeneity with osteoporotic vertebral fractures. Trabecular vBMD was higher in the middle subregion of the vertebrae than the superior and inferior subregions. The fracture group had lower mean integral vBMD than controls. In terms of the spatial distribution, significant differences in the superior/middle and inferior/middle ratios of the L1 vertebra were observed between the fracture and control groups in the female 40-60 years group. The superior/middle ratio of the L1 vertebra in males was positively correlated with the fracture risk. Regarding heterogeneity, the fracture group had a higher QCV than the control group. QCV was positively correlated with fracture risk, with no significant variation between sexes. The spatial distribution and heterogeneity of trabecular vBMD are crucial for predicting vertebral fracture risk. These indicators are essential for fracture risk assessment and may inform prevention and treatment strategies.