Vertebral bone quality score as a novel tool for bone mineral density assessment: which measurement approach is more...

This study compared single-segment and multi-segment lumbar vertebral bone quality (VBQ) score measurements in assessing bone mineral density (BMD), diagnosing osteoporosis, and predicting thoracolumbar fragility fractures to determine the more accurate and practical method.

A retrospective analysis was conducted on patients who underwent lumbar spine MRI and dual-energy X-ray absorptiometry (DEXA) at the First Affiliated Hospital of Anhui Medical University between August 2019 and August 2023. After applying inclusion and exclusion criteria, 210 patients were enrolled(86 with fractures, 124 without). On sagittal T1-weighted MRI images, regions of interest (ROI) were placed within the trabecular bone from L1 to S1 and adjacent cerebrospinal fluid (CSF). VBQ was calculated as the ratio of vertebral trabecular bone signal intensity (SI) to CSF SI. Both single-segment (VBQ_L1, VBQ_L2, VBQ_L3, VBQ_L4, VBQ_L5, VBQ_S1) and multi-segment (VBQ_L1~L4, VBQ_L1~L5, VBQ_L1~S1) VBQ scores were evaluated. Correlations between VBQ and DEXA-derived BMD (BMD_DEXA/T-score) were analyzed. Diagnostic accuracy for osteoporosis and fragility fractures was assessed using receiver operating characteristic (ROC) curves.

All VBQ scores significantly correlated with BMD_DEXA/T-score. Among single segments, VBQ_L2 showed the strongest correlation with T-score (r = -0.345) and best AUC for osteoporosis and low BMD prediction. Among multi-segment scores, VBQ_L1~L4 had the strongest correlation (r = -0.319) and best overall diagnostic performance (low BMD AUC = 0.696; fracture AUC = 0.580).

VBQ scores demonstrated weak-to-moderate correlations with BMD_DEXA and limited diagnostic utility (all AUC < 0.70). Among single segments, L2 performed slightly better, whereas the L1 ~ L4 average was marginally superior among multi-segment approaches. VBQ should therefore serve as a supplementary screening adjunct to DEXA or CT, rather than a stand-alone diagnostic tool, especially for patients who have undergone lumbar MRI but cannot access DEXA/CT.