Prediction of lumbar vertebral body compressive strength of overweight and obese older adults using morphed subject-specific finite-element models to evaluate the effects of weight loss.

ABSTRACT

BACKGROUND: Diet and exercise can promote weight loss in older adults; however, there is potential to increase fracture risk due to loss of bone mineral density (BMD) known to accompany weight loss. Weight loss effects on measures of bone quality and strength are currently unknown. AIMS: The purpose of this study is to develop subject-specific finite-element (FE) models of the lumbar spine and study the effect of intentional weight loss on bone strength in a pilot data set. METHODS: Computed tomography (CT) scans of the lumbar spine of 30 overweight and obese (mean BMI = 29.7 ± 3.9 kg/m2), older adults (mean age = 65.9 ± 4.6 years) undergoing an 18-month intentional weight loss intervention were obtained at baseline and post-intervention. Measures of volumetric BMD (vBMD) and variable cortical thickness were derived from each subject CT scan. Development of the subject-specific FE models of the lumbar spine involved model morphing techniques to accelerate the development of the models. vBMD-derived material properties and cortical thickness measures were directly mapped to baseline and post-intervention models. Bone strength was estimated through simulation of a quasi-static uniaxial compression test. RESULTS: From baseline to 18-month post-weight loss intervention, there were statistically significant decreases in estimated bone strength (6.5% decrease; p < 0.05). Adjusting for baseline bone measures and gender revealed no statistically significant correlations between weight change and change in vBMD, cortical thickness, or bone strength. CONCLUSION: Integration of CT-based measures and FE models with conventional areal BMD can improve the understanding of the effects of intentional weight loss on bone health.