Lumbar Muscle Involvement in the Occurrence of Osteoporotic Vertebral Fracture

Purpose or Learning Objective: To determine if a lumbar musculature deficit (paravertebral [PVM] and psoas [PM] muscles) is associated with a higher prevalence of vertebral fractures in osteoporotic subjects.

Methods or Background: To constitute the fracture group, data were collected retrospectively from patients with one or more recent osteoporotic vertebral fractures between T10 and L5, using variables such as noninjected computed tomography (CT), dual-energy X-ray absorptiometry (DEXA), weight, and height. A control group was created by matching the patients on age, bone mineral density measured by DEXA, and sex. We analyzed PM and PVM atrophy based on cross-sectional area (CSA) adjusted to the body area, as well as fatty infiltration on a three-level scale and the average muscle density in Hounsfield units (HU).

Results or Findings: A total of 117 patients were included in each group. The fracture group had a lower PVM CSA than the control group (2,197.92 ± 460.19 versus 2,335.20 ± 394.42 mm².m⁻², respectively; P = 0.015), but no significant difference was found in the PM (746.92 ± 197.89 versus 731.74 ± 215.53 mm².m⁻², respectively; P = 0.575). The fracture group had a higher grade of fatty infiltration than the control group (PM: 1.3 ± 0.46 versus 1.07 ± 0.25; P < 0.001; PVM: 1.93 ± 0.5 versus 1.74 ± 0.5; P = 0.003) and a lower average muscle density (PM: 26.99 ± 12.83 versus 33.91 ± 8.12 HU; P < 0.001; PVM: 3.42 ± 21.06 versus 12.94 ± 18.88 HU; P < 0.001).

Conclusion: This study shows an association between a lack of axial musculature and the occurrence of osteoporotic vertebral fractures. Preventive strengthening exercises could be proposed to osteoporotic patients.

Publication History

Article published online:
26 May 2023