Comparison of the predictive values of MRI-based vertebral bone quality scores for the determination of osteoporosis in different diseases

Purpose The study aimed to examine the consistency of vertebral bone quality (VBQ) scores for assessing osteoporosis across different etiologies and explore the predictive value of various VBQ scores for fragility vertebral fractures. Methods Patients with fragility fractures were matched by age and sex to patients with lumbar degeneration. VBQ scores were calculated in T1- and T2-weighted magnetic resonance imaging. Differential analysis of bone quality was performed based on etiology. Results A total of 96 inpatients were retrospectively enrolled. VBQ(T1) scores were only sensitive to osteoporotic bone in degenerative group (p < 0.01), failing to identify osteoporosis in fractured group (p > 0.05). For the degenerative group, the area under the curve (AUC) using the VBQ(T1) scores to differentiate osteoporosis was 0.72. After controlling the confounding variables, only VBQ(T2) scores were significantly higher in fractured group than degenerative group, with a greater AUC of 0.82 predicting fragility fractures. VBQ(T1 )scores moderately correlated with femoral neck T-scores in degenerative group (r = -0.45, p < 0.01) but not in fractured group (r = -0.24, p > 0.05). VBQ(T2) scores were not associated with femoral neck T-scores (p > 0.05). Conclusion This study is the first to evaluate the effectiveness of VBQs scores in assessing osteoporosis post-fracture. Only non-fractured patients' bone quality is fully susceptible to VBQ(T1) scores. While VBQ(T1) scores may not correlate with fragility fractures, VBQ(T2) scores present a viable alternative.