Differential effects of bone mineral content and bone area on vertebral strength in a swine model

Since the biomechanical competence of a vertebral body may be closely related to the content and distribution of the bone mineral, we have evaluated the effects of projected vertebral bone area (BA) and bone mineral parameters [bone mineral content (BMC) or bone mineral density (BMD)] on their biomechanical competence. We used dual-energy X-ray absorptiometry (DXA) to assess the bone mineral parameters of 36 swine thoracic vertebrae (T1-T12) and 15 lumbar vertebrae (L1-L5) after removal of the posterior elements. The failure load, compressive stress, and the stored strain energy of these vertebral bodies were assessed by a uniaxial compressive test using an MTS 810 testing system. Multiple regression analysis showed a significantly negative effect of BA and significantly positive effect of BMC on the biomechanical competence (compressive stress, r2 = 0.67, P < 0.0001; failure load, r2 = 0.75, P < 0.0001). However, the stored strain energy was only related to the BMC (r2 = 0.35, P < 0.0001). The contributory effects of BMC and BA on the biomechanical competence were not equal. The effects of BMC was larger than BA in determining the failure load and stored strain energy, whereas the reverse was found for the compressive stress. Using the log-transformed parameters as the regressors resulted in similar results. These results suggested the differential effects of BA and BMC in determining the biomechanical competence of vertebral bodies. We recommend the use of both parameters instead of BMD alone for evaluation of the vertebral biomechanical competence.