Vertebral fractures in the elderly may not always be "osteoporotic"

Jiang, G, Luo, Jin ORCID:, Dolan, P, Adams, MA and Eastell, R (2010) Vertebral fractures in the elderly may not always be "osteoporotic". Bone, 47 (1). pp. 111-116. ISSN 8756-3282

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Vertebral fractures in the elderly are often assumed to be “osteoporotic” and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between “osteoporotic” fractures of vertebrae with low BMD and strength, and “traumatic” fractures of vertebrae with normal BMD and strength.


73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3 mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4 mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA).


Failure load was proportional to BMD (R = 0.63, p < 0.001). “Osteoporotic,” “traumatic” and “no discernible” fractures were reported in 16, 26 and 31 specimens respectively. “Traumatic” fracture specimens had higher BMD and failed at higher loads than “osteoporotic” fracture specimens (p < 0.05).


Some vertebral fractures in the elderly may be traumatic rather than osteoporotic in origin. Our radiological criteria help to differentiate between them.

Item Type: Article
Identifier: 10.1016/j.bone.2010.03.019
Additional Information: Dr Jin Luo's contribution to this research was funded by Action Medical Research and the Hospital Saving Association Charitable Trust. Manuscript preparation was partly funded by the National Institute for Health Research via its Biomedical Research Units (BRU) funding scheme for musculoskeletal health (April 2008 to March 2012). We would like to thank the ‘BRU editorial board’ and Sister Judith Finigan for their suggestions and comments on this manuscript. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Keywords: Vertebral fracture, Osteoporosis, Trauma, Radiographs, ABQ method
Subjects: Construction and engineering > Biomedical engineering
Medicine and health
Medicine and health > Physiology
Related URLs:
Depositing User: Jin Luo
Date Deposited: 08 May 2020 22:04
Last Modified: 06 Feb 2024 16:02

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