Jul 2026· Bone· pp.
118029
· 0 citations· 31 references
Medicine
TL;DR
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.
Abstract
Objective
MRI-derived vertebral bone quality (VBQ) scores estimate vertebral marrow-related bone quality on T1-weighted imaging and may complement dual-energy X-ray absorptiometry (DXA) in spine patients. Discordance between VBQ and DXA is common, particularly in the lumbar spine, where degenerative changes may bias DXA measurements. This study aimed to identify physiological determinants associated with lumbar VBQ-DXA discordance.
Methods
We retrospectively included 266 consecutive adults with preoperative lumbar MRI and DXA performed within 6 months before surgery. Lumbar VBQ was calculated as the ratio of the median T1 signal intensity of the L1-L4 vertebral bodies to cerebrospinal fluid signal intensity. Correlations between VBQ, DXA-derived T-scores, and clinical and laboratory variables were examined, and multivariable regression was used to identify independent determinants of VBQ. Concordance and discordance phenotypes were defined using the lower T-score from the lumbar spine and femoral neck (DXA-normal: ≥ -1.0; DXA-abnormal: < -1.0) and an ROC-derived VBQ threshold.
Results
VBQ was positively correlated with age (r = 0.706, p < 0.001) and moderately inversely correlated with both lumbar spine T-score (r = -0.396, p < 0.001) and femoral neck T-score (r = -0.374, p < 0.001). ROC analysis showed moderate discrimination of DXA-defined osteoporosis, with an AUC of 0.728. At the cutoff of 2.685, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 65.1%, 70.8%, 30.1%, 91.3%, and 69.9%, respectively. In multivariable regression, triglycerides (β = 0.397, p = 0.003), very low-density lipoprotein cholesterol (β = 1.325, p = 0.002), glycated albumin (β = 0.184, p = 0.003), and conjugated bilirubin (β = 0.162, p = 0.004) were independent determinants of VBQ. The DXA-normal/VBQ-abnormal phenotype showed enrichment of this TG/VLDL-C/GA/CB metabolic pattern.
Conclusions
Lumbar VBQ-DXA discordance is associated with a physiological signature characterized by triglyceride-rich lipoproteins, glycation burden, and conjugated bilirubin. VBQ may complement DXA by identifying metabolically vulnerable, marrow-related bone quality changes that are not fully captured by DXA-derived T-scores.
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.
Margrit Elis Müller, João Paulo Colhado Ferreira, Laura Mulazzani Minuzzi Macedo et al.· Skeletal Radiology· 0 citations
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
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
In patients undergoing cervical spine surgery, C-VBQ demonstrates consistent associations with C-HU and DXA T-scores, supporting its potential for opportunistic preoperative bone quality assessment and Integrating radiological indicators such as C-VBQ and C-HU with DXA and BTMs may enable a more comprehensive, but still cautiously interpreted, perioperative bone health evaluation.
Xiaoteng Feng, Xiujia Xia, Zelin Shen et al.· European spine journal· 0 citations
OBJECTIVE
This study aimed to compare the efficacy of endplate Hounsfield unit (HU) values and endplate bone quality (EBQ) scores in predicting cage subsidence (CS) after posterior lumbar interbody fusion (PLIF) in older patients and identify the most discriminative bone mineral density (BMD) assessment indicator.
METHODS
This retrospective analysis included consecutive patients who underwent PLIF at the authors' institution between January 2016 and February 2024. Clinical data were collected for all patients. Propensity scores were used to match patients with and without CS, and the matched cohort was subjected to conditional logistic regression to investigate the association between radiographic factors and CS. L1 and endplate HU values were derived from CT scans, whereas vertebral bone quality (VBQ) and EBQ scores were derived from MR images. Receiver operating characteristic curve analysis was conducted to assess the predictive value of endplate HU values and EBQ scores for CS and further compare their predictive value with that of L1 HU values and VBQ scores.
RESULTS
This study included 130 matched patients. The CS group demonstrated lower L1 (p < 0.001) and endplate HU (p < 0.001) values and higher VBQ (p = 0.002) and EBQ (p < 0.001) scores compared with the non-CS group. The conditional logistic regression analysis identified L1 HU value (OR 0.99, 95% CI 0.97-0.99; p = 0.036), endplate HU value (OR 0.99, 95% CI 0.98-0.99; p = 0.044), VBQ score (OR 2.40, 95% CI 1.34-4.32; p = 0.038), and EBQ score (OR 4.46, 95% CI 2.16-9.18; p = 0.003) as independent predictors of CS, demonstrating areas under the curve of 0.722, 0.815, 0.648, and 0.782, respectively. The optimal cutoff for the endplate HU value in predicting CS was 262.11 (sensitivity 83.08%, specificity 73.85%).
CONCLUSIONS
Endplate HU values indicated a relatively higher predictive performance for CS compared with EBQ scores and served as the most discriminative BMD indicator in patients who underwent PLIF. Measuring the endplate HU value preoperatively helps surgeons select a more appropriate surgical plan and is expected to improve patient outcomes.
Peng Du, Minghui Liang, Ruiyuan Chen et al.· Journal of Neurosurgery : Sp...· 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