Diffuse idiopathic skeletal hyperostosis in an 83-year-old female body donor with osteoporosis – protection or risk for the occurrence of insufficiency fractures of the spine?

Zusammenfassung

Einleitung Die vorliegende Studie hatte das Ziel, Erkenntnisse über Veränderungen in der Knochendichte und der kortikalen Dicke bei Patienten mit diffuser idiopathischer skelettaler Hyperostose (DISH) und Osteoporose zu gewinnen, um das Verständnis für Risikobereiche für das Auftreten von Insuffizienzfrakturen am Achsenskelett zu verbessern.

Fallbeschreibung und Ergebnisse Eine weibliche 83-Jährige Körperspenderin mit DISH und Osteoporose wurde mittels CT/QCT- sowie Mikro-CT-Bildgebung untersucht. Die kortikale Dicke wurde an den Endplatten und der kortikalen Schale von 15 Wirbelkörpern an 1800 Messpunkten ermittelt, um Unterschiede zwischen den Wirbelsäulen Abschnitten festzustellen. Alle erhobenen Daten wurden mit dem Softwarepaket SPSS, Version 24.0 (Armonk, New York: IBM Corp., USA) analysiert. Es zeigte sich eine signifikant höhere kortikale Dicke in der Brustwirbelsäule im Vergleich zur Hals- (p=0,001) und Lendenwirbelsäule (p<0,001). Die Kortikalisdicke ist an der Hinterkante in den verschiedenen Abschnitten am geringsten ausgeprägt. Der spongiöse Knochenmineralgehalt steigt in den von DISH betroffenen Wirbelkörpern an. Obwohl die Halswirbelsäule nicht von DISH betroffen war, fand sich dort die höchste Knochendichte der gesamten Wirbelsäule.

Schlussfolgerungen Die signifikant höhere kortikale Dicke und der erhöhte spongiöse Knochenmineralgehalt in der Brustwirbelsäule bei DISH könnte auf eine erhöhte Stabilität und ein geringeres Frakturrisiko in diesem Bereich hinweisen. Die hohe Knochendichte im HWS-Bereich scheint auch bei vorliegender Osteoporose am Achsenskelett einen kritischen Frakturschwellenwert nicht zu unterschreiten.

Abstract

Introduction The present study aimed to gain insights into changes in bone density and cortical thickness in patients with diffuse idiopathic skeletal hyperostosis (DISH) and osteoporosis, in order to improve understanding of risk areas for the occurrence of insufficiency fractures in the axial skeleton.

Case Description and Results An 83-year-old female body donor with DISH and osteoporosis was examined using CT/QCT and micro-CT imaging. Cortical thickness was determined at the endplates and cortical shell of 15 vertebral bodies at 1800 measurement points to identify differences between spinal sections. All collected data were analyzed using the SPSS software package, version 24.0 (Armonk, New York: IBM Corp., USA). A significantly higher cortical thickness was observed in the thoracic spine compared to the cervical (p=0.001) and lumbar spine (p<0.001). Cortical thickness is least pronounced at the posterior edge in the different sections. The trabecular bone mineral content increases in the affected vertebral bodies in DISH. Although the cervical spine was not affected by DISH, it exhibited the highest bone density among the entire spine.

Conclusions The significantly higher cortical thickness and increased trabecular bone mineral content in the thoracic spine in DISH may indicate increased stability and a lower fracture risk in this area. The high bone density in the cervical spine region also does not seem to fall below a critical fracture threshold, even in the presence of osteoporosis in the axial skeleton.

Schlüsselwörter

Computertomografie - diffuse idiopathische Skeletthyperostose - Knochenmineralgehalt - Kortikalisdicke - Mikro-CT

Keywords

Computed tomography - diffuse idiopathic skeletal hyperostosis - bone mineral content - cortical thickness - micro-CT

Publication History

Received: 09 July 2023

Accepted: 16 October 2023

Article published online:
20 November 2023

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