Unlocking Osteoporosis Diagnosis: Unveiling the Potential of MRI-Based Vertebral Bone Quality Score

Osteoporosis is the most common skeletal disease in humans. The current gold standard technique to diagnose osteoporosis is the measurement of bone mineral density (BMD) using dual-energy x-ray absorptiometry (DEXA). However, DEXA overestimates BMD when there are degenerative changes. Vertebral bone quality (VBQ) score may serve as a supplementary technique.

To explore the value of VBQ score in diagnosing osteoporosis in patients with and without degenerative changes. To formulate a cut-off VBQ score for diagnosing osteoporosis.

A retrospective study was conducted using the data of 112 patients who underwent radiographs, MR imaging, and DEXA scans of the lumbar spine in our hospital over a period of one year from July 2023 to 2024. The patients were divided into degenerative and control groups based on radiographic findings. VBQ score was calculated as the ratio of mean signal intensity (SI) of L1 to L4 vertebral bodies and signal intensity (SI) of cerebrospinal fluid (CSF) at L3 on T1. Demographic data, BMD, and T-score were recorded. Pearson correlation coefficient was used to compare the VBQ score with the BMD and T-score. The VBQ score threshold was obtained and compared with the efficacy of osteoporosis diagnosis based on DEXA.

The degenerative group was older than the control group (70.1 vs. 59.8, P = 0.001). The VBQ score of the control group suggested a higher correlation with BMD value and T-score (r = -0.506 and -0.520, respectively). The BMD value and T-score in the degenerative group were higher (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the VBQ score had good predictability for osteoporosis (area under the curve (AUC) = 0.804), with 71.4% sensitivity and 81.8% specificity in the control group. Based on the T-score, there was no significant difference in the prevalence of osteoporosis between the degenerative and control groups (18.5% vs. 24.1%, P= 0.46); based on the VBQ score, the prevalence in the degenerative group was significantly higher (55.5% vs. 40.9%, P= 0.025).

MRI-based VBQ score is a simple, easy-to-calculate tool and does not require exposure to ionizing radiation to analyze bone quality. VBQ scores potentially overcome the shortcomings of DEXA for diagnosing osteoporosis, especially in older patients with more degenerative changes, where setting DEXA may give spurious results. VBQ score may be used as a supplementary tool along with DEXA. However, MRI is an expensive investigation, and its utility as a diagnostic tool for osteoporosis in the absence of other indications, such as degenerative disc disease, may not be justified. Further studies with larger sample sizes are required to formulate a VBQ score threshold cut-off value for osteoporosis diagnosis.