Current fracture risk estimates for the spine are based on average measures of bone mineral density (BMD) in the vertebral centrum. However, these measures of BMD explain only ∼60% of the variance in vertebral strength [1] and do not discriminate well between fracture and non-fracture cohorts [2]. These limitations of average BMD are likely due to the heterogeneous distribution of bone tissue throughout the vertebra. The density and architecture of vertebral trabecular bone vary as a function of position in the centrum [3]; moreover, these spatial variations have been shown to vary substantially among individuals and with age [3].

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