Routine MRI for opportunistic osteoporosis screening: diagnostic accuracy of vertebral bone quality and a novel femoral bone quality score compared with DXA.
Aug 2026· Skeletal Radiology· 0 citations· 18 references
Medicine
TL;DR
VBQ can serve as an opportunistic exploratory screening marker of low BMD and FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.
Abstract
Objectives
To evaluate vertebral bone quality (VBQ) and femoral bone quality (FBQ) scores as potential imaging markers of bone mineral density (BMD) for opportunistic osteoporosis screening in at‑risk patients and to assess their correlation with DXA T-scores.
Methods
This retrospective cross-sectional study included women ≥ 40 years and men ≥ 50 years who underwent DXA and lumbar spine, hip, or pelvic MRI within 60 days. All MRI examinations were performed at 1.5 T. VBQ and FBQ were obtained using manually placed circular ROIs. FBQ was derived from coronal T1-weighted images using two approaches: femoroacetabular joint fluid (FBQfa) and cerebrospinal fluid (FBQcsf). Interobserver reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations with DXA T-scores and diagnostic performance for osteoporosis were analyzed using Pearson coefficients and ROC curves.
Results
Among 248 patients, VBQ demonstrated excellent reproducibility (ICC = 0.922) and a weak-to-moderate negative correlation with DXA T-scores (r = -0.307; p < 0.001). VBQ values increased across DXA bone density categories, with an optimal cutoff of 3.61 for osteoporosis (AUC = 0.71). FBQcsf showed high reproducibility (ICC = 0.874) compared with FBQfa (ICC = 0.462) but no evidence of correlation with DXA (p = 0.151). FBQcsf distinguished normal BMD from osteopenia (p = 0.002) and, after adjustment for age and sex, also differentiated patients with osteopenia from those with osteoporosis (p = 0.011).
Conclusion
VBQ can serve as an opportunistic exploratory screening marker of low BMD. FBQcsf may complement VBQ by identifying early marrow-related changes, although further validation is required.
Both HU and VBQ offer useful assessments of vertebral bone quality, but HU provides higher and more stable diagnostic accuracy, demonstrating higher sensitivity, specificity, and accuracy for detecting osteopenia and osteoporosis.
Omar Lubbad, Akram Hagos, Laila Lubbad et al.· European Radiology· 0 citations
Lumbar VBQ-DXA discordance is associated with a physiological signature characterized by triglyceride-rich lipoproteins, glycation burden, and conjugated bilirubin, which may complement VBQ by identifying metabolically vulnerable, marrow-related bone quality changes that are not fully captured by DXA-derived T-scores.
Jie Hao, Fayao Yan, Yu Yao et al.· Bone· 0 citations
When CT is available, HU appears to be the better-supported opportunistic marker for low BMD than VBQ, and AUC-based diagnostic discrimination of HU was consistent across vertebrae, with slightly better results at L2 and the mean of L1–L4.
Luc W.F. van Haaster, Erem Tutal, R. Mekary et al.· Brain and Spine· 0 citations
Background/Objectives: This study aimed to evaluate whether artificial intelligence-derived vertebral volumetric bone mineral density (AI-vBMD) and paraspinal intermuscular adipose tissue (IMAT) ratio from routine computed tomography (CT) could identify moderate-to-severe vertebral compression fractures (VCFs) in breast cancer survivors, and whether paraspinal IMAT ratio and routinely available clinical variables improved diagnostic performance. Methods: This retrospective study included 275 women with breast cancer who underwent routine non-contrast CT and lumbar quantitative computed tomography (QCT). Hounsfield unit-derived volumetric bone mineral density (HU-vBMD) was derived using a QCT-referenced HU-to-vBMD conversion equation, whereas AI-vBMD and paraspinal IMAT ratio were extracted using automated software. Moderate-to-severe VCF was defined as Genant grade ≥ 2. Agreement with QCT-vBMD was assessed using correlation, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Model discrimination was evaluated using receiver operating characteristic analysis and DeLong tests. Results: Moderate-to-severe VCF was present in 75 patients (27.3%). HU-vBMD and AI-vBMD showed excellent agreement with QCT-vBMD (ICC, 0.978 and 0.987, respectively). AI-vBMD outperformed HU-vBMD for identifying VCFs (AUC, 0.738 vs. 0.714; p < 0.001). IMAT ratio showed comparable standalone discrimination to AI-vBMD (AUC, 0.760 vs. 0.738; p = 0.604). Adding IMAT ratio to AI-vBMD improved discrimination (AUC, 0.786 vs. 0.738; p = 0.038). The full model incorporating clinical covariates achieved the highest AUC (0.828; 95% CI, 0.778–0.878). Conclusions: AI-vBMD and paraspinal IMAT ratio automatically extracted from routine CT improved the diagnostic assessment of prevalent moderate-to-severe VCFs in breast cancer survivors. This study supports an automated CT-based approach that integrates vertebral bone density and paraspinal muscle–fat information for opportunistic identification of clinically relevant VCFs.
Chen Wan, Lingquan Kong, Jie Hao et al.· Journal of Clinical Medicine· 0 citations
Among lipid parameters evaluated, only high-density lipoprotein cholesterol (HDLC) was positively associated with VBQ scores; however, this weak association did not significantly compromise the diagnostic performance of VBQ for osteoporosis.
Fangke Hu, Dapeng Yu, Penghe Li et al.· Asian Spine Journal· 0 citations
Spine-hip BMD discordance is common among Jordanian adults undergoing DXA, particularly in those assessed using T-scores, underscoring the importance of multisite DXA assessment to improve diagnostic accuracy and fracture risk evaluation.
Mais Alqoudah, Mu’taz Massad, Zain aldeen Saleh et al.· Journal of clinical densitom...· 0 citations
