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Predictive Performance of VBQ Scores and Hounsfield Units for Subsequent Fractures After Vertebral Augmentation: A
Song Wang1, Dun Liu1, Tao Kang1
1Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (S.W., D.L., T. K., Y.H., H.J.).
Rationale And Objectives:
Osteoporosis substantially increases the risk of subsequent fractures (SF) after vertebral augmentation (VA). Magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) scores and computed tomography (CT)-derived Hounsfield unit (HU) values are indicators of bone quality. This meta-analysis investigated the diagnostic accuracy of VBQ and HU values for identifying SF following VA.
Materials And Methods:
Relevant studies were retrieved from PubMed, Embase, and the Cochrane Library through December 31, 2025. Study quality was evaluated using the QUADAS-2. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were synthesized. Sensitivity analyses and meta-regression were performed to explore sources of heterogeneity.
Results:
Twenty-nine studies (7364 patients) were included. Study quality was assessed using QUADAS-2, with most studies showing a low risk of bias. VBQ in the SF group was significantly higher than in the non-SF group (mean difference = 0.58, 95% CI: 0.41-0.74, P < 0.001; I² = 85%), whereas the HU value was significantly lower (mean difference = -24.69, 95% CI: -28.46 to -20.92, P < 0.001; I² = 87%). The areas under the HSROC curves for VBQ and HU were 0.85 and 0.82, respectively, with sensitivities of 0.85 and 0.79, and specificities of 0.66 and 0.70. Meta-regression indicated SF site was the source of heterogeneity for VBQ, whereas no significant modifiers were found for HU.
Conclusion:
Both VBQ and HU values effectively differentiate patients with SF after VA surgery. VBQ demonstrates superior diagnostic performance and may serve as a reliable indicator for predicting the risk of SF following VA.
