Teriparatide enhances vertebral bone quality: Quantitative analysis using the VBQ score in lumbar fusion patients

Vertebral bone quality is a critical factor influencing spinal stability and surgical planning. The vertebral bone quality (VBQ) score, derived from routine MRI, has emerged as a noninvasive imaging biomarker of bone quality; however, its clinical implications in the perioperative spinal fusion setting remain incompletely understood.

This retrospective study included patients who underwent single-level lumbar fusion at L4-5. VBQ was measured at T12-L2 to avoid instrumentation-related artifacts. Associations between VBQ and radiographic parameters were evaluated using correlation and multivariable regression analyses. Inter- and intra-rater reliability were assessed using kappa statistics.

VBQ scores significantly decreased in the PTH group (ΔVBQ -0.31 ± 0.56), indicating improved bone quality, whereas no improvement was observed in controls (ΔVBQ 0.08 ± 0.61; p = 0.03). HU changes did not differ between groups. ΔVBQ correlated with postoperative BMD (r = -0.28, p = 0.04) and PTH duration (r = -0.39, p = 0.01). Regression analysis identified PTH use (β = -0.39, 95%CI: -0.72 to -0.06, p = 0.02) and treatment duration (β = -0.27, 95%CI: -0.52 to -0.02, p = 0.03) as independent predictors of VBQ improvement with R² of 0.32.

Perioperative teriparatide significantly enhances vertebral bone quality, demonstrated by reduced VBQ scores over 12 months. VBQ appears more sensitive than HU or BMD to anabolic therapy-induced qualitative changes and may serve as a practical imaging biomarker for optimizing perioperative bone management in osteoporotic spinal fusion patients.