The influence of pelvic tilt on regional bone mineral density of the sacrum: A quantitative CT analysis.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42480288.
- Also identified by DOI 10.1016/j.injury.2026.113517.
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Abstract
Spinopelvic alignment plays a crucial role in the biomechanical load distribution of the lumbosacral junction. Pelvic tilt (PT), as a key sagittal alignment parameter, reflects compensatory pelvic rotation and increases with age and degenerative spinal changes. While sacral insufficiency fractures represent a growing clinical problem in elderly populations, the relationship between pelvic orientation and regional sacral bone mineral density remains poorly understood. To investigate the association between pelvic tilt and regional trabecular bone mineral density within the S1 vertebra using quantitative computed tomography (QCT). In this retrospective study, 204 patients who underwent CT imaging of the spine and standing radiographs of the lumbar spine between 2017 and 2024 were analyzed. Trabecular volumetric bone mineral density (vBMD) was measured using QCT at five predefined anatomical regions within S1: right lateral mass of S1 (MLR), right sacral ala (ALR), vertebral body S1 (CS1), left sacral ala (ALL), and left lateral mass of S1 (MLL). Pelvic tilt was measured on standing lateral radiographs. Associations between pelvic tilt, bone mineral density, age, and sex were assessed using correlation analysis and multivariable linear regression. Pelvic tilt increased significantly with age and was higher in women than in men. Trabecular bone mineral density decreased across all measured regions with increasing age. Pearson correlation analysis demonstrated a significant negative association between pelvic tilt and vBMD at all anatomical regions. After adjustment for age and sex, pelvic tilt remained an independent negative predictor of bone mineral density at ALR, CS1, and ALL. Pelvic tilt is associated with regional variations in sacral bone mineral density, particularly in the sacral alae and the S1 vertebral body. These findings suggest that sagittal spinopelvic alignment is associated with regional differences in trabecular bone density within the sacrum.