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Diagnostic accuracy of MRI-Based vertebral bone quality score for detecting low bone mass and osteoporosis: A
M D Wulandari1, P Jorisal2, C B H Sulay3
1Musculoskeletal Radiology, Department of Radiology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Radiology, Siloam Hospital, Mampang, Indonesia.
Introduction:
Dual-energy X-ray absorptiometry (DXA) is the reference standard for osteoporosis diagnosis, but access remains limited in many settings. MRI-based vertebral bone quality (VBQ) has emerged as an opportunistic screening tool derived from routine lumbar imaging; however, its diagnostic performance is uncertain.
Methods:
A PRISMA-DTA-compliant systematic review and meta-analysis (PROSPERO CRD420251264768) was conducted across five databases (2020-December 2025). Studies evaluating lumbar VBQ against DXA were included. Pooled sensitivity, specificity, likelihood ratios, and hierarchical summary ROC curves were estimated using a bivariate random-effects model for two contrasts: (1) normal vs. low bone mass and (2) non-osteoporosis vs. osteoporosis.
Results:
Thirty-six studies (6521 participants) were included. For detecting low bone mass, pooled sensitivity was 72% and specificity 67% (AUC 0.75). For diagnosing osteoporosis, sensitivity was 67% and specificity 75% (AUC 0.77). Likelihood ratios were modest (LR+ 2.19-2.73; LR- 0.42-0.43), indicating limited rule-in and rule-out capability. Substantial heterogeneity (I2 98-99%) and publication bias were observed. Test performance varied with disease prevalence and sex distribution.
Conclusion:
VBQ demonstrated only moderate diagnostic accuracy, with substantial heterogeneity and modest likelihood ratios limiting its rule-in and rule-out capability. Accordingly, it is best suited for opportunistic case-finding rather than definitive diagnosis.
Implications For Practice:
VBQ is best used for opportunistic case-finding during routine lumbar MRI. Elevated VBQ values should prompt confirmatory DXA rather than guide treatment decisions independently. Incorporating VBQ into routine reporting may improve early identification of at-risk patients, particularly when lumbar MRI has already been performed for another clinical indication.