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Cortical Bone Assessment Using Ultrasonic Guided Waves: A Reproducibility Study in a Healthy Population

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Novel MRI-based scoring system for bone fragility evaluation in spinal disorders.

Zhuanghui Wang¹, Yongxin Chen¹, Jue Zhang¹

¹The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|May 27, 2026

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A new vertebral bone fragility (VBF) score accurately assesses bone density in patients with degenerative lumbar diseases. This simple MRI-based method aids in preoperative evaluation, correlating well with dual-energy X-ray absorptiometry (DEXA) scans.

Area of Science:

Orthopedics and Spine Surgery
Radiology and Medical Imaging
Bone Health and Osteoporosis Research

Background:

Optimal bone quality is crucial for spinal surgery success, reducing complication risks.
Assessing vertebral bone fragility is vital for patient selection and surgical planning.
Current methods for bone density assessment may have limitations in clinical practice.

Purpose of the Study:

To develop a novel, simple, and clinically relevant scoring system for vertebral bone fragility (VBF).
To evaluate the correlation between the VBF score and conventional dual-energy X-ray absorptiometry (DEXA) measurements.
To establish VBF score as a reliable tool for preoperative bone mineral density (BMD) screening.

Main Methods:

Retrospective analysis of 109 patients with degenerative lumbar diseases undergoing lumbar spine MRI and DEXA scans.

Keywords:

Bone fragility MRI Osteoporosis VBF VBQ

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Categorization into normal and osteopenia/osteoporosis groups based on DEXA results.

Calculation of vertebral bone quality (VBQ), disc signal intensity (DSI), and vertebral bone fragility (VBF) scores; logistic and Pearson correlation analyses; ROC curve evaluation.

Main Results:

The VBF score showed excellent interobserver reliability.
A high VBF score was a significant risk factor for osteopenia/osteoporosis (OR 2.870).
VBF score demonstrated high diagnostic performance (AUC 0.829) and significant correlation with DEXA T-scores (p < 0.001).

Conclusions:

The VBF score is a straightforward, reliable, and accurate method for assessing bone fragility.
It offers an additional screening option for preoperative BMD evaluation in patients with degenerative lumbar diseases.
This MRI-based approach enhances preoperative assessment of bone quality for spinal surgery.