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Purpose: Sixty percent of myeloma patients develop pathologic fractures, with the majority occurring in the spine or ribs. The purpose of this study was to determine whether trabecular microstructural analysis can be used to predict new pathologic spinal fractures in myeloma patients. Materials and methods: A total of 22 vertebral bodies from 14 patients with multiple myeloma were examined by 64-detector row CT prior to follow-up CT that showed new pathologic spinal fractures. Tissue bone mineral density (tBMD), trabecular parameters, and mechanical properties were calculated for three vertebrae, comprising a vertebra that would become fractured and the two adjacent vertebrae. Areas of lytic lesions were also obtained in the axial images containing the largest lytic lesions. For data analysis, univariate analysis was used to compare indices between vertebrae that would develop fractures and those that would not. Multivariate logistic regression analyses and receiver operating characteristic curves were also used. Results: Univariate analysis demonstrated that area of lytic lesion, trabecular spacing, structure model index, tBMD, and failure load were significantly associated with the occurrence of pathologic fractures. Multivariate analysis identified area of lytic lesion, tBMD, and failure load as significant predictors of pathologic fractures. The area under the curve was 0.779 for failure load, 0.641 for tBMD, and 0.632 for area of lytic lesion. Conclusion: Trabecular microstructural analysis can be used to predict new pathologic fractures in myeloma patients. Failure load and tBMD predict pathologic fractures better than the presence of a lytic lesion in a vertebra.

journal of musculoskeletal disorders and treatment

A Longitudinal Study of the Prediction of Pathologic Spinal Fractures in Multiple Myeloma with Trabecular Microarchitecture and CT-Based Finite Element Analyses