Paraspinal FI, a marker of muscle quality deterioration, provides complementary risk information beyond BMD and FRAX and may help identify high-risk individuals who are underestimated by traditional assessments.
Abstract
Background
Osteoporotic vertebral compression fractures (OVCFs) are often underestimated by conventional tools. Paraspinal muscle quality changes, especially reduced cross-sectional area (CSA) and increased fatty infiltration (FI), may provide additional clinical value for OVCF risk.
Materials And Methods
We retrospectively enrolled 258 osteoporosis patients aged ≥50 years. After propensity score matching, 129 patients with vertebral fractures and 129 without fractures were included. Demographics, BMD T-scores, and FRAX scores were collected. Paraspinal muscle CSA and FI at the L3 level were quantified on axial T2WI using ImageJ. Group comparisons and multivariable logistic regression were performed, and diagnostic performance was evaluated using ROC analysis.
Results
Compared with the non-fracture group, fracture patients had significantly lower weight, BMI, and CSA but higher FRAX scores and FI. FI remained elevated in the fracture group across all BMI subgroups (P<0.05), whereas CSA reduction was significant only in the normal-weight subgroup (P=0.001). FI was an independent risk factor for OVCF (OR=1.091, 95% CI: 1.041-1.144; P<0.001). FI showed higher discrimination (AUC=0.702) than BMD T-score (AUC=0.517) and FRAX (AUC=0.592). The combined model achieved the best performance (AUC=0.776; sensitivity 54.4%, specificity 89.7%; all P<0.05).
Discussion
Paraspinal FI, a marker of muscle quality deterioration, provides complementary risk information beyond BMD and FRAX and may help identify high-risk individuals who are underestimated by traditional assessments.
Conclusion
Paraspinal muscle FI is an independent risk factor for OVCF and improves prediction when added to traditional tools.
BACKGROUND
Osteoporotic vertebral compression fractures (OVCFs) are prevalent but frequently remain unrecognized. While bone mineral density (BMD) is the primary assessment tool, MRI-based parameters associated with bone and muscle quality may offer additional value, yet sex-specific analyses are limited, despite sex differences in incidence and hormones.
PURPOSE
To explore the associations between MRI-based vertebral bone quality (VBQ) score, psoas muscle index (PMI), and paravertebral muscle fat infiltration (FI) fraction with OVCFs, and to assess the potential diagnostic performance of MRI parameters across sexes.
STUDY TYPE
Retrospective.
POPULATION
260 subjects (≥ 50 years); 130 OVCF patients (73.0 years (67.0-80.0), 89 females) and 130 non-fracture (NF) patients (64.5 years (58.0-73.0), 76 females).
FIELD STRENGTH AND SEQUENCES
3 T and 1.5 T. T1-weighted TSE and T2-weighted TSE (Siemens) and T1-weighted FSE and T2-weighted FSE (United Imaging).
ASSESSMENT
VBQ was calculated on sagittal T1-weighted MRI; PMI and FI were quantified on axial T2-weighted MRI at the L3 endplate by ImageJ. BMD was derived from CT using QCT PRO software. Two trained observers, blinded to clinical data, performed all MRI measurements.
STATISTICAL TESTS
Significance level was set at p < 0.05. t-test/Mann-Whitney U test, chi-squared test (χ2), Spearman's rank correlation coefficient, multivariate logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). Bootstrap resampling (1000 iterations) for internal validation.
RESULTS
The OVCF group exhibited significantly elevated VBQ (3.71 ± 0.55 vs. 3.25 ± 0.58) and FI (24.11% (21.66-28.92) vs. 20.31% (18.90-22.14)), while PMI (3.42 ± 1.02 vs. 4.08 ± 1.14) and BMD (55.82 mg/cm3 (38.75-70.90) vs. 89.24 mg/cm3 (67.80-110.00)) were reduced. FI was independently associated with OVCFs exclusively in females (OR = 1.566). The combined MRI model (VBQ + FI + PMI) yielded a significantly higher AUC in females (AUC = 0.896) than in males (AUC = 0.720).
DATA CONCLUSION
VBQ, PMI, and FI reveal significant sex-specific correlations with OVCFs. The multi-parametric MRI model shows considerable potential as a diagnostic aid for OVCFs in individuals aged over 50, particularly in females.
LEVEL OF EVIDENCE: 4
TECHNICAL EFFICACY STAGE
2 (Diagnostic Accuracy).
Meng Sun, Wanling Jiang, Haoyu Wang et al.· Journal of Magnetic Resonanc...· 1 citation
Objective To explore the multiple risk factors for intercostal neuralgia after osteoporotic thoracic vertebral compression fractures (OVCF), and to construct a clinical prediction model. Methods The clinical data of 280 patients with single-segment thoracic OVCF admitted to our orthopedic department from January 2022 to December 2025 were retrospectively collected. Patients were categorized into neuropathic pain (NP) and non-neuropathic pain (non-NP) groups based on the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, with a score of ≥12 defining the primary outcome of intercostal neuralgia as neuropathic pain. Demographic data, fracture-related parameters, bone density, bone metabolism markers, and psychological status (Hospital Anxiety and Depression Scale, HADS) were collected. Univariate and multivariate Logistic regression analyses were used to screen independent risk factors, and the discrimination of the prediction model (area under the ROC curve, AUC) was evaluated. The model’s performance was internally validated using the Bootstrap method. Results Among the 280 patients, the incidence of neuropathic pain was 21.8% (61/280). Multivariate analysis identified six independent risk factors: middle thoracic fracture (T5-T8, OR=4.603), thoracolumbar fascia injury (TLFI, OR=4.883), injured vertebral width ratio (per 0.1 increase, OR=3.973), decreased bone mineral density T-score (per 1-unit decrease, OR=2.685), intravertebral vacuum cleft (IVC, OR=2.764), and depressive state (HADS≥8, OR=2.586). The prediction model showed good calibration (Hosmer-Lemeshow P=0.412) and discrimination (AUC=0.843, 95% CI: 0.789–0.897), with sensitivity 80.3%, specificity 76.7%, and negative predictive value 93.2%. Bootstrap internal validation yielded an optimism-corrected AUC of 0.831. Conclusion Post-fracture intercostal neuralgia in osteoporotic thoracic vertebrae is multifactorial. Middle thoracic vertebra fractures, injury of the thoracolumbar fascia, increased ratio of injured vertebra width, decreased bone density, intravertebral vacuum fissure, and depressive state are independent risk factors. However, external validation in prospective multicenter studies is required before routine clinical implementation.
Dongliang Xiao, Yong-Guang Xu· International Journal of Gen...· 0 citations
FRAX-derived fracture probability in postmenopausal women is associated not only with bone-related parameters but also with muscle structure, muscle quality, and physical performance, which highlights the potential relevance of muscle-related parameters within the broader musculoskeletal profile reflected by FRAX.
Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) combined with alfacalcidol in the treatment of osteoporotic vertebral compression fractures (OVCF), and to explore the impact on bone metabolism and functional recovery. Methods This retrospective study included 120 patients with single-level OVCFs who underwent PKP between January 2021 and January 2023. Patients were divided into two groups: the basic treatment group (BT, n = 60) received standard postoperative care including calcium and vitamin D supplementation; the alfacalcidol group (AFC, n = 60) received additional oral alfacalcidol. Clinical parameters—including bone mineral density (BMD), bone metabolism markers (NMID, P1NP, β-CTX), Visual Analog Scale (VAS) for pain, and Japanese Orthopaedic Association (JOA) scores—were recorded preoperatively, and at 6 and 12 months postoperatively. Results Both groups showed significant postoperative improvement in BMD, VAS, and JOA scores. However, the AFC group demonstrated greater increases in BMD and more pronounced reductions in bone turnover markers at both follow-up points (P < 0.05). Additionally, pain relief and functional recovery were significantly better in the AFC group. No serious adverse events were observed. Conclusion PKP combined with alfacalcidol is more effective than PKP alone in improving bone metabolism, relieving pain, and promoting functional recovery in patients with OVCF. This combination therapy addresses both the structural and metabolic aspects of osteoporosis and may help reduce future fracture risk.
Sihua Jin, Zhi-Dong Wang, H. Quan et al.· Frontiers in Surgery· 0 citations
Purpose The purpose of this study was to evaluate the association between systemic low bone mineral density (BMD) and subchondral insufficiency fracture (SIF) of the knee in women, and to explore whether this association is modified by radial meniscal tears. Materials and methods In this case-control study, women with and without MRI-confirmed SIF who had available dual-energy X-ray absorptiometry T-score measurements were included. Systemic BMD was categorized using T-scores. Multivariable logistic regression models with BMD as the exposure and SIF as the outcome, adjusting for age and body mass index were fitted. An exploratory stratified analysis to assess potential effect modification by meniscal radial tear status was also conducted. Results A total of 121 women with SIF (mean age, 69.1 ± 7.5 [standard deviation] years) and 124 controls (70.4 ± 8.3 [standard deviation] years) were analyzed. After adjustment, osteoporosis was associated with higher odds of SIF (odds ratio [OR], 2.29; 95% confidence interval [CI]: 1.03–5.09), whereas osteopenia (OR, 1.33; 95% CI: 0.69–2.55) showed no significant association. In exploratory stratified analysis to test for effect modification, there were no significant interactions between low BMD and radial root tears (P-interaction = 0.178). However, small strata likely limited the power to detect a significant effect modification, as evidenced by overlapping wide 95% CIs. Conclusion Osteoporosis is associated with higher odds of SIF of the knee in women, while osteopenia is not.
M. Alzaher, Wasim Issa, Tuhina Neogi et al.· Diagnostic and Interventiona...· 0 citations
INTRODUCTION
Osteoporotic vertebral fractures (OVF) present varying treatment challenges depending on fracture severity, stability, and patient characteristics. While the OF classification system guides treatment decisions, gender differences in OVF management and outcomes remain underexplored.
RESEARCH QUESTION
How do treatment strategies and clinical outcomes differ between genders?
METHODS
This secondary analysis utilized prospective data from the German multicenter EOFTT study, including 518 patients (390 females, 128 males) treated for thoracolumbar OVF. Outcomes assessed included adherence to OF score recommendations, pain levels, functional performance (Timed Up & Go test, Barthel Index, Oswestry Disability Index), and rates of anti-osteoporotic therapy (aoTh). Statistical analyses included generalized linear mixed models and repeated-measures general linear models, with therapy type as a covariate.
RESULTS
Gender did not influence overall treatment choice; however, men more frequently underwent instrumentation, while women received augmentation procedures. AoTh administration was significantly lower in men at discharge (72% vs. 82%, p = 0.017) and follow-up (71% vs. 89%, p < 0.001). Both genders showed significant improvements in pain, mobility, and functional outcomes over time (p < 0.001), with no gender-specific differences. Adherence to OF score recommendations was 61% with no gender disparity.
DISCUSSION AND CONCLUSION
Although gender had minimal influence on pain and functional recovery, marked differences in surgical strategies and the administration of anti-osteoporotic therapy underscore potential disparities in the surgical treatment of women and the management of osteoporosis in men. Addressing these disparities through tailored screening, optimized adherence to guidelines, and individualized treatment strategies may improve outcomes in OVF management.
P. Schenk, Helena Arias, U. Spiegl et al.· European spine journal· 0 citations