The Ratio of Anterior and Posterior Vertebral Heights Reinforces the Utility of DXA in Assessment of Vertebrae Strength

The objective of the study was to introduce a new parameter describing bone strength with greater precision than the widely used antero-posterior DXA (dual-energy X-ray absorptiometry), which measures areal bone mineral density (aBMD). The adjusted areal bone mineral density (AaBMD) defined as the ratio between aBMD and h (a)/h (p) (h (a) and h (p): anterior and posterior vertebral body heights measured on the lateral view, respectively) is proposed: AaBMD = aBMD/(h (a)/h (p)). The utility of AaBMD in prediction of bone strength was assessed by in vitro measurements of cadaver L3 vertebrae. The AaBMD of 31 vertebrae was correlated with the ultimate stress (P (max)) and load (F (max)) values obtained in mechanical tests. The correlations were compared to those obtained for aBMD and for volumetric bone mineral density (vBMD) measured by computed tomography. The correlation of AaBMD to F (max) adjusted for donor’s age was significantly higher than for aBMD and vBMD (r = 0.740, 0.658, and 0.609, respectively, p < 0.05). The differences between partial correlation coefficients for P (max) to AaBMD, aBMD and vBMD relationships were smaller (r = 0.764, 0.720, and 0.732, respectively, p < 0.05), but also showed the superiority of AaBMD. Combining antero-posterior DXA aBMD and the lateral h (a)/h (p) ratio, measured, for example, by the Vertebral Fracture Assessment software of the new generation of DXA devices, seems to accurately predict the mechanical vertebral parameters related to bone strength. It is assumed that the proposed AaBMD parameter may be more predictive for fracture risk assessment, which requires further studies.