Dynamic Change of Lumbar Structure was Associated with Reduced Bone Mineral Density, a Clinical Retrospective Study

doi:10.21203/rs.3.rs-1553074/v1

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Dynamic Change of Lumbar Structure was Associated with Reduced Bone Mineral Density, a Clinical Retrospective Study

https://doi.org/10.21203/rs.3.rs-1553074/v1

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posted 19 Apr, 2022

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Objectives: This study aims to determine whether the dynamic change of lumbar anatomy parameters is associated with bone mineral density.

Methods: This retrospective study included participants who did lumbar computed tomography (CT) scanning from October 2018 to December 2021. The established and recorded CT scanning images were used for analysis. Bone mineral density (BMD) was determined by the qCT value. CT scanning was also used to measure angle between upper and lower endplate on median sagittal view, and that between pedicle center and horizontal alignment on median sagittal view and transverse section angle on the axial view.

Results: 476 participants were included. Angle between upper and lower endplate on median sagittal view in lumbar 1 (5.72±3.60), lumbar 2 (4.03±3.14), lumbar 3 (2.60 ±3.08) was positively associated with BMD, while that in lumbar 4 (2.07±4.66) was negatively associated (All P<0.05). Furthermore, angle between pedicle center and horizontal alignment on median sagittal view in lumbar 1 (-1.89±6.49), lumbar 2 (-2.10±6.96), and lumbar 3 (-0.75±5.61) was positively associated with BMD (P<0.001 for them all). However, this angle in lumbar 4 (2.99±4.78) showed no correlation with BMD (P=0.961). However, no significant correlation was observed between transverse section angle on the axial view and BMD.

Conclusion: The dynamic change of lumbar anatomy parameters is associated with BMD and thus orthopadic surgeons should pay attention to these changes in the internal fixation operation.

dynamic change

lumbar structure

anatomy parameters

osteoporosis

bone mineral density.

Studies in embryology and anatomy indicate human’s bone is in dynamic remodeling from infants and young children period to adult stage[1]. In the embryonic period, around 7th week, bone starts to form. Continually, bone develop to skeletal maturity around adult stage[2]. During this development period, bone’s capacity, such as mass, shape and strength is also changing[3]. For instance, femoral neck torsion angle is well-established to be found around 30°-40°at the infant stage, while this angle gradually changing into around 15°in adolescence stage[4]. Additionally, femoral neck shaft angle is around 150°in infant stage, while this angle gradually changes to approximate 125°when bone is mature[5, 6]. Besides the change from infant period to adult, after bone maturation, the changing is still going on. For examples, the curve of upper fibula is increasing with age[7]. Moreover, lumbar anatomy structure is also in dynamic change[8]. In addition, femoral neck rake angle and collodiaphyseal angle is decreased with aging. In contrast, acetabular rake is positive associated with age[9, 10].

It’s widely accepted that biochemical molecules play important role in bone remodeling both in bone absorption and deposition[11]. Importantly, it’s well-established that biomechanical signal is in the central role in conducting or transducing or initiating the biochemical reactions[12]. In addition, the biomechanical signals triggered biochemical responds turns to be age-related. In detail, age is found to be related between cortical bone properties and mechanical function[1]. Bone mineral density is a critical marker which indicates bone mass. Bone mass reaches its apex around age of 35[13, 14]. Generally, before age of 35, bone mass is gradually accumulated, however, bone loss happens after age of 35. Importantly, due to the change of hormone, after age of 60, more bone loss is seen in female than male. Wolff’s law also illustrates bone’s mass and strength changes after maturation. In nature, bone adapts to the mechanical loads. Bone’s mass and strength increases when the local mechanical load increases. In contrast, bone’s mass and strength decreases in case of atrophy of disuse[15].

Bone works as the scaffold in human body. With aging, bone loss happens, resulting in osteopenia or osteoporosis. Osteoporosis is characterized by decreased bone mass, microstructure destruction and increased risk of fracture[16]. Due to bone mass is decreased, bone can no longer sustain its capacity for holding the existed biomechanical loads. In that case, the shape of bone changes to adapt to its function. For examples, the upper fibula curve changes to support knee joint; the height of lumbar vertebrae decreases to hold body weight in aged population[8, 17]. However, this change compensatory helps body adapt to maintain its function, the change of bone shape results in deformative diseases, such as degenerative osteoarthritis and spinal kyphosis[8, 17, 18]. Interestingly, methods have been taken by surgeons to recover the force line by reforming the bone shape or local structure in knee joint, and the established operation achieves successful outcome[19]. Additionally, drugs against osteoporosis also indicates beneficial effect in the degenerative diseases, including osteoarthritis[20].

Taken the fact that lumbar vertebrae are in dynamic change and bone mass is changing with aging, present study aims to determine whether lumbar anatomy parameters are associated with bone mineral density. Since male and female exhibits different bone mineral density, herein we investigated whether this association is gender-depended.

Participants deemed to eligible to be included meet the criteria: ethnic Han population; eligible imaging data for measurement; clear record of age and gender. Participants who were excluded from this study were: individual with endocrine system diseases such as hyperparathyroidism, hyperthyroidism, diabetes mellitus, Hashimoto’s thyroiditis, hypoparathyroidism and hypothyroidism; spinal trauma diseases such as vertebral fractures; congenital and developmental anomalies such as congenital spine structure abnormality and idiopathic scoliosis; infections such as intervertebral infection, spinal tuberculosis, spinal brucellosis and vertebral body infection; abdominal neoplasms; spinal tumor; immune system diseases such as rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis; and patients with clear hormone use history.

This study included 476 consecutive participants, male 210 and 264 female, who did lumbar CT scanning in Qilu Hospital of Shandong University between October 2018 and December 2021. Participants’ age ranged from 17 to 87 years old, with a mean of 55.19 ± 14.28 years old. Two observers measured the lumbar parameters blindly and recorded independently. Two investigators collected all information and did statistical analysis blindly and independently. The picture archiving and communication systems (PACS) was taken advantage of for measuring lumbar morphology. Participants’ consents were waived because the design of this study was retrospective. And participants’ information was anonymized.

2. Measurement methods and parameters

2.1 Measurement method

Participants were selected according to the established criteria. All information and CT images were acquired in workstation by using PACS. Two investigators measured the lumbar anatomy parameters without knowing participants’ name, gender and age. These investigators recorded these parameters independently. Statistic analysts did statistical analysis based on the collected information blindly.

2.1 Angle between upper and lower endplate (AULE)

Angle between upper and lower endplate (AULE) was defined as following: in one vertebra body, the angle between “a” and “b”. “a” is the line cross upper endplate and “b” is the line cross lower endplate. Measurement method: the image was set on median sagittal view, the angle between above mentioned “a” and “b” of the same vertebral body was determined by PCAS. Clinical significance: spine sagittal balance was associated with this parameter. The bigger of this parameter, the severer kyphosis might happen. The AULE from lumbar 1 to lumbar 4 was determined in this study (Figure.1A).

2.2 Sagittal section angle (SSA)

Sagittal section angle (SSA) was defined as followings: the angle between pedicle center and the horizontal alignment. Measurement method: the CT scanning image was set on median sagittal reconstructive view, the line of horizontal alignment was recorded as “a”, and the line of pedicle center was recorded as “b”. The angle between “a” and “b” was SSA. The angle was recorded as “-” when “b” was below “a”. The angle was recorded as “+” when “b” is above “a”. Clinical significance: This angle was critical for pedicle screw insertion. SSA was determined from lumbar 1 to lumbar 4 in this study (Figrue.1B).

2.3 Transverse section angle (TSA)

Transverse section angle (TSA) was defined as followings: Magerl point was the classic pedicle insertion point which was the cross point of tangent to the outer edge of the superior articular process and the medial transverse process. Line “a” was drawn by crossing the Magerl point and the pedicle center; line “b” was drawn by the median sagittal line. TSA is the angle between “a” and “b”. Measurement method: The cross section was set layer by layer, and TSA was determined by recognizing above mentioned “a” and “b”. Clinical significance: This angle was critical for pedicle screw insertion. TSA from lumbar 1 to lumbar 4 was determined in this study (Figure.1C).

2.3 qCT determination

The value of qCT was used for the quantification of bone mineral density. The value of qCT was acquired by PACS analysis. The interested zone of vertebral body was selected and the qCT value was shown automatically in the established system.

3. Statistical Analysis

The baseline characteristics (mean, standard deviation) of all participants were calculated. Student’s t test or Wilcoxon rank sum test was used to determine the differences in means between participants of different genders. Groups with various bone mineral density assessed by differences in means was determined by using Kruskal-Wallis H test. Pearson product-moment correlation coefficient (r) was calculated and scatter plots were shown to investigate the correlation between bone mineral density and lumbar structure anatomy parameters. Regression coefficients (β) and R² was calculated by univariable linear regression. Significant statistic difference was regarded when p value less than 0.05. In this study, gender was analyzed as a qualitative variable and other parameters were analyzed as quantitative variables. All analyses were done using R (version 3.5.1, The University of Auckland, New Zealand). Potential association was analyzed by Pearson correlation coefficient analysis. Correlation results were interpreted according to the value as followings: no or very week correlation (-0.1 to 0.1), weak correlation (-0.3 to -0.1 or 0.1 to 0.3), moderate correlation (-0.5 to -0.3 or 0.3 to 0.5), and strong correlation (-1.0 to -0.5 or 1.0 to 0.5). The independent association was determined by multiple linear regression. P < 0.05 (two-tailed) was considered statistically significant. A highly significant difference was defined as P < 0.01 (two-tailed).

Lumbar anatomy parameters and bone mineral density

To determine whether lumbar anatomy parameters was associated with bone mineral density (BMD), we selected participants strictly according to the criteria retrospectively. As indicated in Table.1, the mean age of the participants was55.19(14.28), while that of male participants was 53.77(14.98), and that of female participants was 56.39(13.59). Additionally, BMD from lumbar 1 to 4 was 150.56 (59.03), 144.73 (59.07), 136.66 (60.31) and 138.92 (60.90), respectively. Lumbar structure parameters were measured as the established methods. In detail, AULE of lumbar 1, 2, 3, 4 was 5.72 (3.60), 4.03 (3.14), 2.60 (3.08), 2.07 (4.66). SSA of lumbar 1, 2, 3, 4 was − 1.89 (6.49), -2.10 (6.96), -0.75 (5.61) and 2.99 (4.78). lastly, TSA of lumbar 1, 2, 3, 4 was 6.97 (1.45), 7.66 (1.65), 8.91 (1.96) and 10.81 (5.76).

In order to determine whether gender altered BMD-associated lumbar anatomy parameters’ change, this study also examined each gender dependently. Detailly, for male, the BMD of lumbar 1, 2, 3, 4 was 153.65(51.68), 151.14(53.48), 140.68 (53.47) and 143.41(52.88), respectively. And AULE of lumbar 1, 2, 3, 4 was 6.71 (3.59), 4.30 (2.94), 2.53 (2.98) and 1.64 (4.25), respectively. In addition, SSA of lumbar 1, 2, 3, 4 was − 1.39 (5.87), -1.54 (6.82), -0.25 (5.55), 2.94 (4.17), respectively. Furthermore, TSA of lumbar 1, 2, 3, 4 was 6.99 (1.42), 7.71 (1.65), 8.88 (1.86), 10.50 (2.20), respectively.

For female, the BMD from lumbar 1 to 4 was 149.10 (63.50), 140.30 (62.55), 134.20 (64.86) and 136.29 (65.85). Additionally, AULE from lumbar 1 to 4 was 4.97 (3.39), 3.82 (3.28), 2.62 (3.13) and 2.34 (4.89). Moreover, SSA from lumbar 1 to 4 was − 2.42 (6.80), -2.66 (6.96), -1.20 (5.63) and 3.05 (5.25). furthermore, TSA from lumbar 1 to 4 was 6.95 (1.48), 7.60 (1.64), 8.91 (2.03) and 11.03 (7.49).

Dynamic change of lumbar structure was associated with bone mineral density

Statistical analysis was taken to determine the association between lumbar structure and bone mineral density. As indicated in Table.2, AULE in lumbar 1, 2, 3 and 4 was corelated to bone mineral density, showing significant statistic difference (P < 0.001, P < 0.001, P = 0.019 and P < 0.001, respectively). In detail, the r value suggested that AULE in lumbar 1(r = 0.2540), 2(r = 0.2540) and 3(r = 0.1113) was positively related to bone mineral density while AULE in lumbar 4(r=-0.2154) was negatively associated with bone mineral density. In addition, SSA in lumbar 1, 2 and 3 was corelated to bone mineral density (P < 0.001, P < 0.001 and P < 0.001, respectively). However, SSA in lumbar 4 showed no significant difference with bone mineral density (P = 0.961). Importantly, r value demonstrated that SSA in lumbar 1, 2 and 3 was increased when bone mineral density was increased. Furthermore, the parameter of TSA in lumbar structure exhibited no association with bone mineral density. The P value of TSA from lumbar 1 to 4 was 0.384, 0.378, 0.315 and 0.884, respectively.

BMD-associated lumbar structure dynamic change was not gender-dependent

To further investigate whether BMD-associated lumbar structure dynamic change was altered in male and female, we next examined the association independently. As illustrated in Table.3 and Fig. 2, male AULE in lumbar 1, 2, 3 and 4 was associated with bone mineral density (P < 0.001, P = 0.001, P = 0.050 and P = 0.024, respectively). Additionally, as r value indicated, male AULE in lumbar 1(r = 0.3717), 2(r = 0.2240) and 3(r = 0.1382) was positively related to bone mineral density. In contrast, male AULE in lumbar 4(r=-0.1613) was negatively associated with bone mineral density. As shown in Table.3 and Fig. 2, female AULE in lumbar 1, 2 and 4 was associated with bone mineral density (P = 0.009, P < 0.001 and P < 0.001, respectively). And female AULE in lumbar 3 demonstrated no significant association with bone mineral density(P = 0.217). Notably, r value suggested female AULE in lumbar 1(r = 0.1619) and 2(r = 0.3029) was positively associated with bone mineral density while female AULE in lumbar 4(r=-0.2335) was negatively associated with bone mineral density. Interestingly, as demonstrated in Fig. 2, with the same bone mineral density, male AULE in lumbar 1 and 2 was overall bigger than that of female. Additionally, male AULE in lumbar 4 was overall smaller than that of female with the same bone mineral density.

As illustrated in Table.2 and Fig. 3, male SSA in lumbar 1, 2 and 3 was associated with bone mineral density (P < 0.001, P < 0.001 and P < 0.001, respectively). While male SSA in lumbar 4 show no significant association (P = 0.063). In addition, this association was positive. Furthermore, as shown in Table.3 and Fig. 3, female SSA in lumbar 1, 2 and 3 was associated with bone mineral density (P < 0.001, P < 0.001 and P < 0.001, respectively). While male SSA in lumbar 4 show no significant association (P = 0.182). Similar as male SSA, female SSA in lumbar 1, 2 and 3 was increased with the increased bone mineral density. Interestingly, as indicated in Fig. 3, with the same bone mineral density, male and female exhibited similar SSA in lumbar 1 and 2.

As suggested in Table.2 and Table.3, male and female TSA from lumbar 1 to 4 exhibited no significant association with bone mineral density. Notably, as demonstrated in Fig. 4, with the same bone mineral density, male TSA exhibited comparable value with female TSA.

Collectively, bone mineral density-associated lumbar anatomy parameter dynamic change did not rely on gender.

Adult degenerative scoliosis(ADS) is a prevalent issue in the elder population which defined as a spinal deformity with a curve over 10° measured by Cobb method in a skeletally mature individual [21, 22]. ADS prevalence is about 6% in people older than 50 years old, the average age of people suffering from ADS sought for medical care is in their sixties. Importantly, the curve is in potential progression with an average of 3.3° every year[23].

In the progression of adult degenerative scoliosis, the spinal structure is changing[24]. In detail, the disc and the facet joint degeneration leads to an asymmetric loading of the spinal segment. Consequently, an asymmetric deformity, for instance, scoliosis or kyphosis occurs. And then at the facet joint (spondylarthritis) and at the vertebral endplates (spondylosis), osteophytes are formed. This change makes a contribution to the increasing narrowing of the spinal canal together with the hypertrophy and calcification of the ligamentum flavum and joint capsules, resulting in central and recessed spinal stenosis.

There are two ways to treat adult degenerative scoliosis: medicine and surgery[25]. Pain relief drugs are used to decrease the symptom. Additionally, surgery is the final way to treat adult degenerative scoliosis. However, there is also disputed for long-segment or short segment treatment for adult degenerative scoliosis[23, 26]. Long segment internal fixation treatment perfectly restores the sagittal balance of human body, however, proximal junctional kyphosis (PJK) is one of the major complications due to decreased bone mineral density in these patients[27, 28]. Even multi-use of anti-osteoporosis drugs does not receive demanded outcome. In other hand, even though short segment internal fixation treatment temporary relieves pain, the body force line remains unbalanced, resulting in progressed adult degenerative scoliosis in long term.

It’s widely accepted that osteoporosis accelerates curve progression. In addition, larger curves tend to progress faster than small curves in adult degenerative scoliosis patients for biomechanical reasons.

Osteoporosis is characterized by a decrease in bone density and abnormal microstructure, which leads to reduced bone strength and increased fracture risk. The population of osteoporosis is around 200 million over the world. Additionally, the morbidity of osteoporosis is around 60% in the population with age over 60[29]. With increasing age, the incidence of osteoporosis and its related diseases, including fracture and kyphosis, occurs. While osteoporosis is often considered a disease common for women, it is also recognized as an important health problem for men[30].

Osteoporosis is classified into primary and secondary type[31]. Importantly, exercise effectively prevents osteoporosis. In osteoporosis environment, biochemical pathways are activated and inflammatory catabolic molecules, such as tumor necrosis factor(TNF), interlukin (IL) and A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) are induced[32, 33]. These induced molecules mediate bone absorption, resulting in severer situation of osteoporosis. However, appropriate mechanical load improves the situation of osteoporosis. The biomechanical load transduced biochemical signals help bone mass deposit[34]. Notably, in the progression of osteoporosis, bone mass losses gradually, the existed bone no longer supports its loads, leading to bone-associated degenerative diseases.

Previous studies demonstrate bone is indeed in dynamic change after maturation[7, 8, 19, 35–37]. For instance, in the knee joint, tibial platform in medial part exhibits a lower height than that in lateral side with aging. Moreover, upper fibula shows larger curve in the elderly population. Furthermore, femoral neck rake angle and collodiaphyseal angle is decreased with aging. In contrast, acetabular rake is positive associated with age. This finding reveals the reason why elderly individual demonstrates extorsion of the lower extremities. Interestingly, lumbar structure is also found to be changed with aging. In detail, lumbar lordosis is increased with aging, indicating the spinal curve is larger and larger in lifetime. Additionally, the transverse section angle is decreased in aged population, suggesting more incidence of spinal stenosis.

Even the finding demonstrates some bones, such as tibia, fibula, femur and lumbar vertebrae are in dynamic change with aging, the involved mechanism still remains unclear. Taken the fact that bone mass is gradually decreased after its peak at the age of 35, and bone mineral density is the key for maintaining bone strength and mass, herein we found the dynamic change of lumbar structure was associated with bone mineral density. Angle between upper and lower endplate (AULE) and sagittal section angle presents the sagittal curve and it’s found to be associated with bone mineral density. Importantly, this association is linearity. Furthermore, this BMD-associate lumbar dynamic change is gender-independent. The phenomena is also true in clinic. The osteoporosis patients usually exhibit bended spine, showing the increased curve in the progression of osteoporosis.

With aging, bone loss gradually processes, leading to osteopenia or osteoporosis. The bone mineral density is also decreased in this progression, leading to reduced strength and microfractures. Consequently, the bone can not support sustained weight, resulting in the shape change to adapt to the mechanical loads. Present study indicates this hypothesis is true in lumbar structure.

Collectively, lumbar structure is in dynamic change in whole life. Bone mineral density’s change initiates bone shape’s change. Additionally, bone mineral density associated change is gender independent. Anti-osteoporosis treatment might be potential for kyphosis and other bone-related degenerative diseases.

AULE: Angle between upper and lower endplate;

SSA: Saggital section angle;

TSA: Transverse section angle;

LL: lumbar lordosis

Ethics approval and consent to participate

The study protocol was approved by the Regional Ethics Board of Hebei Medical University (T2016-001-1).

Availability of data and materials

In accordance with institutional policy for patients' medical records, data used in this study are not open publicly, but will be available upon motivated request to the corresponding author of this paper.

Competing interests

All of the authors declared no conflict of interest.

Author contributions:

Yingze Zhang conceived and designed the study; Jianlu Wei, Lingjia Fan, Yanbin Zhu and Hong Wang inquired the medical records and collected the relevant data; Guangfei Li, Wei Chen and Lei Cheng performed the analyses and interpreted the results; Jiali Lv and Tao Zhang prepared the tables and figures; Jianlu Wei and Yanbin Zhu drafted the manuscript and Lei cheng and Yingze Zhang approved the final version; all authors reviewed and approved for publication.

Acknowledgments

The study was partly supported by National Natural Science Foundation of China (81900804), China Postdoctoral Science Foundation Grant (2019M651064) and Shandong Provence Natural Science Foundation (ZR2019BH071).

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Table.1 Basic information of all participants in the study (mean (SD))

	Male	Female	All Participants	P value
Age（yr）	53.77 (14.98)	56.39 (13.59)	55.19 (14.28)	0.046
L1 BMD	153.65 (51.68)	149.10 (63.50)	150.56 (59.03)	0.401
L1 AULE	6.71 (3.59)	4.97 (3.39)	5.72 (3.60)	＜0.001
L1 SSA	-1.39 (5.87)	-2.42 (6.80)	-1.89 (6.49)	0.083
L1 TSA	6.99 (1.42)	6.95 (1.48)	6.97 (1.45)	0.749
L2 BMD	151.14 (53.48)	140.30 (62.55)	144.73 (59.07)	0.046
L2 AULE	4.30 (2.94)	3.82 (3.28)	4.03 (3.14)	0.099
L2 SSA	-1.54 (6.82)	-2.66 (6.96)	-2.10 (6.96)	0.080
L2 TSA	7.71 (1.65)	7.60 (1.64)	7.66 (1.65)	0.460
L3 BMD	140.68 (53.47)	134.20 (64.86)	136.66 (60.31)	0.244
L3 AULE	2.53 (2.98)	2.62 (3.13)	2.60 (3.08)	0.766
L3 SSA	-0.25 (5.55)	-1.20 (5.63)	-0.75 (5.61)	0.069
L3 TSA	8.88 (1.86)	8.91 (2.03)	8.91 (1.96)	0.835
L4 BMD	143.41 (52.88)	136.29 (65.85)	138.92 (60.90)	0.203
L4 AULE	1.64 (4.25)	2.34 (4.89)	2.07 (4.66)	0.099
L4 SSA	2.94 (4.17)	3.05 (5.25)	2.99 (4.78)	0.801
L4 TSA	10.50 (2.20)	11.03 (7.49)	10.81 (5.76)	0.321

Table.2 Association between lumbar parameters and bone mineral density stratified by gender

	AULE			SSA			TSA
	r	b	P value	r	b	P value	r	b	P value
L1	0.2540	0.0147	<0.001	0.4838	0.0517	<0.001	0.0405	0.0009	0.384
L2	0.2728	0.0113	<0.001	0.5105	0.0599	<0.001	0.0410	0.0011	0.378
L3	0.1113	0.0041	0.019	0.4075	0.0366	<0.001	0.0471	0.0013	0.315
L4	-0.2154	-0.0115	<0.001	-0.0023	-0.0001	0.961	-0.0068	-0.0002	0.884

Table.3 Association between lumbar parameters and bone mineral density in male participants.

	AULE			SSA			TSA
	r	b	P value	r	b	P value	r	b	P value
L1	0.3717	0.0237	<0.001	0.4858	0.0529	<0.001	0.0674	0.0017	0.336
L2	0.2240	0.0117	0.001	0.4973	0.0634	<0.001	0.0427	0.0012	0.544
L3	0.1382	0.0061	0.050	0.4906	0.0500	<0.001	0.0665	0.0020	0.344
L4	-0.1613	-0.0101	0.024	0.1303	0.0089	0.063	-0.0189	-0.0007	0.788

Table.4 Association between lumbar parameters and bone mineral density in female participants.

	AULE			SSA			TSA
	r	b	P值	r	b	P值	r	b	P值
L1	0.1619	0.0085	0.009	0.4878	0.0521	<0.001	0.0237	0.0005	0.704
L2	0.3029	0.0110	<0.001	0.5153	0.0573	<0.001	0.0139	0.0004	0.823
L3	0.0788	0.0027	0.217	0.3685	0.0309	<0.001	0.0029	8.4*10^-5	0.963
L4	-0.2335	-0.0108	<0.001	-0.0855	-0.0054	0.182	0.0038	0.0001	0.952

No competing interests reported.

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posted 19 Apr, 2022

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Dynamic Change of Lumbar Structure was Associated with Reduced Bone Mineral Density, a Clinical Retrospective Study

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Abstract

Figures

Introduction

Methods And Materials

2. Measurement methods and parameters

2.1 Measurement method

2.1 Angle between upper and lower endplate (AULE)

2.2 Sagittal section angle (SSA)

2.3 Transverse section angle (TSA)

3. Statistical Analysis

Results

Lumbar anatomy parameters and bone mineral density

Dynamic change of lumbar structure was associated with bone mineral density

BMD-associated lumbar structure dynamic change was not gender-dependent

Discussion

Abbreviations

Declarations

References

Tables

Competing Interests

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