Lumbar vertebral body compressive strength evaluated by dual-energy X-ray absorptiometry, quantitative computed tomography, and ashing.

Bone densitometry with DXA (dual energy X-ray absorptiometry) and QCT (quantitative computed tomography) techniques are used for in vivo assessment of bone strength and thereby prediction of fracture risk. However, only few in vitro studies have investigated and compared these techniques' ability to determine vertebral compressive strength. The aim of the present study was to (1) assess the predictive value of DXA, QCT, and pQCT (peripheral QCT) for vertebral bone compressive strength assessed by mechanical testing; (2) describe both linear and power relationship between density and strength; and (3) evaluate whether gender-related differences in the above relations were present. The material comprised human lumbar vertebrae L3 from 51 women and 50 men (age range: 18 to 96 years). The study showed that both DXA and CT techniques (QCT and pQCT) have a high predictive value for vertebral strength. The DXA BMD had a high correlation with maximum compressive load (r2 = 0.86). The QCT and pQCT had high correlations with maximum compressive stress (r2 = 0.75 and r2 = 0.86, respectively). The correlation between ash density of the biomechanically tested specimen and maximum compressive stress was r2 = 0.88. There were no differences between linear and power fit in the degree of determination between density and strength. There was no gender-related difference in the relationship between volumetric density and maximum compressive stress. In conclusion, it was demonstrated that DXA, QCT, and pQCT are ex situ equally capable of predicting vertebral compressive strength with a degree of determination (r2) between 75% and 86%. No differences were found between linear and power analysis of the relationship between density and strength, and no difference was found in the density strength relationship between women and men.