{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:00:07Z","timestamp":1790618407675,"version":"4.1.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Studies of cancellous bone density across all spinal segments in relation to age and sex remain limited. This investigation aimed to quantify vertebral cancellous bone density in Hounsfield units (HU), to explore age\u2011 and sex\u2011related bone loss, and to compare HU measurements with bone mineral density (BMD) and bone volume fraction (BV\/TV). Cancellous bone density was assessed in 71 spines (CT) covering vertebrae C3-L5 and the age range from 4 to 102 years. HU values were derived from mid\u2011vertebral regions, and in addition, BMD (L1-L3) and BV\/TV measurements (Th12-L2, micro\u2011CT, 50 spines) in broad subsets of samples. The association between bone density and age was investigated by HU profiles along the spine in age groups and by regression approaches. HU values decreased with age (p\u2009&lt;\u20090.001) and from cranial to caudal levels (p\u2009&lt;\u20090.001), for both sexes (p\u2009&lt;\u20090.001), with a marked reduction at the thoracolumbar junction beyond 60 years. Regression and cluster analyses revealed two phases of HU density loss with ongoing age, the second occurring in women (older than 64 years), later than in men (after 56 years) (p\u2009&lt;\u20090.001). HU values were correlated with BMD (r\u2009=\u20090.86; 95% CI: 0.72\u20130.94) and with BV\/TV (r\u2009=\u20090.51; 95% CI: 0.17\u20130.75). Density loss of bone with age is significant for BMD (for both sexes, p\u2009&lt;\u20090.001) and for BV\/TV (p\u2009\u2264\u20090.021), too, with an earlier reduction detected in the microarchitecture. These findings highlight the need for sex\u2011specific assessment and prevention strategies in osteoporosis research and clinical care.<\/jats:p>","DOI":"10.1371\/journal.pone.0358344","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:26:21Z","timestamp":1790616381000},"page":"e0358344","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigation of age- and sex-related changes in cancellous bone density in the human spine using CT"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9953-3987","authenticated-orcid":true,"given":"Guido","family":"Schr\u00f6der","sequence":"first","affiliation":[{"name":"Academic Teaching Hospital of the University of Rostock","place":["Hohenfelde, Germany"],"department":["Clinic for Orthopaedics and Trauma Surgery, Sana Hospital Bad Doberan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1179-6932","authenticated-orcid":true,"given":"Aleksander J.","family":"Owczarek","sequence":"additional","affiliation":[{"name":"Medical University of Silesia","place":["Katowice, Poland"],"department":["Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Akl","sequence":"additional","affiliation":[{"name":"Rostock University Medical Center","place":["Rostock, Germany"],"department":["Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"G\u00f6tz","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Technology, Rostock University Medical Center","place":["Rostock, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffi S. I.","family":"Falk","sequence":"additional","affiliation":[{"name":"Hand and Reconstructive Surgery, Rostock University Medical Center","place":["Rostock, Germany"],"department":["Department of Trauma Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mittlmeier","sequence":"additional","affiliation":[{"name":"Hand and Reconstructive Surgery, Rostock University Medical Center","place":["Rostock, Germany"],"department":["Department of Trauma Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hiepe","sequence":"additional","affiliation":[{"name":"Institute of Anatomy, Rostock University Medical Center","place":["Rostock, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"B\u00fcttner","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Rostock University Medical Center","place":["Rostock, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dau","sequence":"additional","affiliation":[{"name":"Rostock University Medical Center","place":["Rostock, Germany"],"department":["Department of Oral & Maxillofacial Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wolter","sequence":"additional","affiliation":[{"name":"Rostock University Medical Center","place":["Rostock, Germany"],"department":["Department of Oral & Maxillofacial Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1385-2793","authenticated-orcid":true,"given":"Julian Ramin","family":"Andresen","sequence":"additional","affiliation":[{"name":"Medical University of Vienna, Waehringer Guertel","place":["Vienna, Austria"],"department":["Division of Trauma Surgery, Department of Orthopaedics and Trauma Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1575-525X","authenticated-orcid":true,"given":"Reimer","family":"Andresen","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology\/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg","place":["Heide, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christof","family":"Schober","sequence":"additional","affiliation":[{"name":"OrthoCoast, Medical Office of Orthopedics and Osteology","place":["Wolgast, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c4nne","family":"Glass","sequence":"additional","affiliation":[{"name":"Institute for Biostatistics and Informatics in Medicine and Ageing Research, Rostock University Medical Center","place":["Rostock, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"4","key":"pone.0358344.ref001","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/jgs.15716","article-title":"Osteoporosis in older persons: old and new players","volume":"67","author":"J Zanker","year":"2019","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"pone.0358344.ref002","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11657-020-00871-9","article-title":"SCOPE 2021: a new scorecard for osteoporosis in Europe","volume":"16","author":"JA Kanis","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"40","key":"pone.0358344.ref003","first-page":"665","article-title":"The incidence of fractures among the adult population of Germany\u2013an analysis from 2009 through 2019","volume":"118","author":"M Rupp","year":"2021","journal-title":"Dtsch Arztebl Int"},{"issue":"4","key":"pone.0358344.ref004","doi-asserted-by":"crossref","first-page":"436","DOI":"10.3171\/2022.11.SPINE22875","article-title":"Alternatives to DEXA for the assessment of bone density: a systematic review of the literature and future recommendations","volume":"38","author":"N Deshpande","year":"2023","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"pone.0358344.ref005","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s12877-024-04737-4","article-title":"Bone mineral density in lower thoracic vertebra for osteoporosis diagnosis in older adults during CT lung cancer screening","volume":"24","author":"N Hu","year":"2024","journal-title":"BMC Geriatr"},{"key":"pone.0358344.ref006","unstructured":"American College of Radiology. Practice parameter for the performance of quantitative computed tomography (QCT) bone densitometry. 2023. https:\/\/gravitas.acr.org\/PPTS\/GetDocumentView?docId=11"},{"issue":"1","key":"pone.0358344.ref007","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1186\/s12877-023-03963-6","article-title":"Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry","volume":"23","author":"W Lin","year":"2023","journal-title":"BMC Geriatr"},{"key":"pone.0358344.ref008","first-page":"547","article-title":"Insuffizienzfrakturen der Wirbels\u00e4ule in Abh\u00e4ngigkeit von der spongi\u00f6sen Knochendichte: Eine in-vitro-Studie","volume":"51","author":"G Schr\u00f6der","year":"2022","journal-title":"Orthopadie (Heidelb)"},{"issue":"10","key":"pone.0358344.ref009","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1185\/03007995.2015.1074892","article-title":"Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis","volume":"31","author":"M Marinova","year":"2015","journal-title":"Curr Med Res Opin"},{"key":"pone.0358344.ref010","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00132-024-04587-3","article-title":"Vergleichende Bewertung der spongi\u00f6sen Knochendichte in Hounsfield-Einheiten im lumbalen nativen CT-Schnittbild zur Osteoporosediagnostik und Frakturrisikobestimmung durch verschiedene Untersucher","volume":"54","author":"JR Andresen","year":"2025","journal-title":"Orthop\u00e4die (Heidelb)"},{"issue":"4","key":"pone.0358344.ref011","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.3390\/jcm14041226","article-title":"Opportunistic osteoporosis assessment and fracture risk determination using cancellous density measurement in hounsfield units of native lumbar computed tomography images-a comparative study with conventional bone density evaluation","volume":"14","author":"JR Andresen","year":"2025","journal-title":"J Clin Med"},{"issue":"11","key":"pone.0358344.ref012","doi-asserted-by":"crossref","first-page":"3335","DOI":"10.1007\/s00402-021-04184-5","article-title":"Correlation of quantitative computed tomography derived bone density values with Hounsfield units of a contrast medium computed tomography in 98 thoraco-lumbar vertebral bodies","volume":"142","author":"F Buenger","year":"2022","journal-title":"Arch Orthop Trauma Surg"},{"issue":"11","key":"pone.0358344.ref013","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2106\/JBJS.J.00160","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"JJ Schreiber","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"pone.0358344.ref014","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1080\/02688697.2021.1888877","article-title":"Estimation of bone mineral density with hounsfield unit measurement","volume":"38","author":"P Aydin Ozturk","year":"2024","journal-title":"Br J Neurosurg"},{"issue":"4","key":"pone.0358344.ref015","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.3390\/jcm14041059","article-title":"Evaluation of cancellous bone density from C3 to L5 in 11 body donors: CT versus micro-CT measurements","volume":"14","author":"G Schr\u00f6der","year":"2025","journal-title":"J Clin Med"},{"key":"pone.0358344.ref016","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics14050498","article-title":"Regional Variations in the Intra- and Intervertebral Trabecular Microarchitecture of the Osteoporotic Axial Skeleton with Reference to the Direction of Puncture","volume":"14","author":"G Schr\u00f6der","year":"2024","journal-title":"Diagnostics"},{"issue":"06","key":"pone.0358344.ref017","first-page":"657","article-title":"Warum sich in der Halswirbels\u00e4ule auch bei Osteoporose nur selten Insuffizienzfrakturen finden","volume":"160","author":"G Schr\u00f6der","year":"2021","journal-title":"Z Orthop Unfall"},{"issue":"1","key":"pone.0358344.ref018","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5115\/acb.20.269","article-title":"A comparison, using X-ray micro-computed tomography, of the architecture of cancellous bone from the cervical, thoracic and lumbar spine using 240 vertebral bodies from 10 body donors","volume":"54","author":"G Schr\u00f6der","year":"2021","journal-title":"Anat Cell Biol"},{"issue":"19","key":"pone.0358344.ref019","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0000000000004877","article-title":"Comparison of bone mineral density in children and adolescents on CT Versus DEXA Scan","volume":"49","author":"K Nagata","year":"2024","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0358344.ref020","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2023.12.073","article-title":"Correlation of hounsfield units with bone mineral density and T-score in chinese adults","volume":"183","author":"X Wang","year":"2024","journal-title":"World Neurosurg"},{"issue":"1","key":"pone.0358344.ref021","doi-asserted-by":"crossref","first-page":"16574","DOI":"10.1038\/s41598-023-43850-z","article-title":"CT and MR for bone mineral density and trabecular bone score assessment in osteoporosis evaluation","volume":"13","author":"H Lee","year":"2023","journal-title":"Sci Rep"},{"issue":"9","key":"pone.0358344.ref022","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/BRS.0000000000004211","article-title":"Efficacy of hounsfield units measured by lumbar computer tomography on bone density assessment: a systematic review","volume":"47","author":"EM Pinto","year":"2022","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"pone.0358344.ref023","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s12891-024-07324-1","article-title":"Bone density of the cervical, thoracic and lumbar spine measured using Hounsfield units of computed tomography - results of 4350 vertebras","volume":"25","author":"G Simion","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"pone.0358344.ref024","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/s13018-022-03105-5","article-title":"Breaking strength and bone microarchitecture in osteoporosis: a biomechanical approximation based on load tests in 104 human vertebrae from the cervical, thoracic, and lumbar spines of 13 body donors","volume":"17","author":"G Schr\u00f6der","year":"2022","journal-title":"J Orthop Surg Res"},{"issue":"11","key":"pone.0358344.ref025","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1038\/s41430-023-01352-1","article-title":"Reference values for body composition in healthy urban Mexican children and adolescents","volume":"78","author":"L-G Desiree","year":"2024","journal-title":"Eur J Clin Nutr"},{"issue":"4","key":"pone.0358344.ref026","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1359\/jbmr.2001.16.4.597","article-title":"Changes in bone density during childhood and adolescence: an approach based on bone\u2019s biological organization","volume":"16","author":"F Rauch","year":"2001","journal-title":"J Bone Miner Res"},{"issue":"3","key":"pone.0358344.ref027","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S8756-3282(98)00091-X","article-title":"Vertebral bone density evaluated by dual-energy X-ray absorptiometry and quantitative computed tomography in vitro","volume":"23","author":"EN Ebbesen","year":"1998","journal-title":"Bone"},{"issue":"8","key":"pone.0358344.ref028","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1359\/jbmr.1999.14.8.1394","article-title":"Age- and gender-related differences in vertebral bone mass, density, and strength","volume":"14","author":"EN Ebbesen","year":"1999","journal-title":"J Bone Miner Res"},{"issue":"12","key":"pone.0358344.ref029","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1359\/jbmr.040916","article-title":"Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites","volume":"19","author":"BL Riggs","year":"2004","journal-title":"J Bone Miner Res"},{"issue":"7","key":"pone.0358344.ref030","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s00198-002-1322-y","article-title":"Aging bone in men and women: beyond changes in bone mineral density","volume":"14","author":"CR Russo","year":"2003","journal-title":"Osteoporos Int"},{"issue":"16","key":"pone.0358344.ref031","doi-asserted-by":"crossref","first-page":"2804","DOI":"10.3390\/nu16162804","article-title":"A comprehensive analysis of bone mineral density changes across the lifespan: insights from national surveys","volume":"16","author":"T Li","year":"2024","journal-title":"Nutrients"},{"issue":"10","key":"pone.0358344.ref032","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1002\/jbmr.3757","article-title":"The prevalence of osteoporosis in china, a nationwide, multicenter DXA survey","volume":"34","author":"Q Zeng","year":"2019","journal-title":"J Bone Miner Res"},{"issue":"2","key":"pone.0358344.ref033","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s001980200001","article-title":"Changes in bone mineral density with age in men and women: a longitudinal study","volume":"13","author":"L Warming","year":"2002","journal-title":"Osteoporos Int"},{"issue":"8","key":"pone.0358344.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271898","article-title":"Causal relationships between sex hormone traits, lifestyle factors, and osteoporosis in men: a Mendelian randomization study","volume":"17","author":"H Wang","year":"2022","journal-title":"PLoS One"},{"issue":"4","key":"pone.0358344.ref035","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S2213-8587(22)00012-2","article-title":"Osteoporosis in men","volume":"10","author":"T Vilaca","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"pone.0358344.ref036","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1002\/jbmr.4543","article-title":"Modest changes in sex hormones during early and middle adulthood affect bone mass and size in healthy men: a prospective cohort study","volume":"37","author":"T Banica","year":"2022","journal-title":"J Bone Miner Res"},{"issue":"1","key":"pone.0358344.ref037","doi-asserted-by":"crossref","first-page":"9977","DOI":"10.1038\/s41598-024-59946-z","article-title":"Age- and sex-related changes in vertebral trabecular bone architecture in Neolithic and Mediaeval populations from Poland","volume":"14","author":"FM Galassi","year":"2024","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:26:27Z","timestamp":1790616387000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358344"}},"subtitle":[],"editor":[{"given":"Melissa Orlandin","family":"Premaor","sequence":"first","affiliation":[{"name":"Federal University of Minas Gerais: Universidade Federal de Minas Gerais","place":["BRAZIL"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358344","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}