The lack of accuracy in the prediction of vertebral fracture risk from average density measurements, all external factors being equal, may be because bone mineral density (BMD) is less than a perfect surrogate for bone strength but also because strength alone may not be sufficient to fully characterize the structural failure of a vertebra. Apart from bone quantity, organization of micro-architecture would have a role in governing mechanical properties of vertebrae. An earlier study indicated that within-vertebra variability, measured as the coefficient of variation (COV) of bone volume fraction (BV/TV) or as COV of finite element-estimated apparent modulus (EFE) correlated well with vertebral strength [1]. Therefore, as an extension to our earlier study, we investigated i) whether the relationships of vertebral strength found with COV of BV/TV and COV of EFE could be extended to the COV of other micro-structural parameters and microcomputed tomography-estimated bone mineral density (μCT-BMD) and ii) whether COV of microstructural parameters were associated with structural ductility measures.

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