Aug 2026· Frontiers in Endocrinology· Vol 17· 0 citations· 33 references
Medicine
Abstract
Background Osteoporotic vertebral compression fractures (OVCFs) predominantly cluster at the thoracolumbar junction (T11-L1). Recent studies suggest that both bone quality and muscle health significantly contribute to vertebral collapse. However, among numerous multidimensional imaging metrics, which one can most accurately predict the severity of vertebral collapse, and whether the precise load-sharing proportions between bone and muscle exhibit distinct segment-specific differences, remain rarely quantified in the clinical literature. Purpose To identify imaging metrics that best predict vertebral collapse severity and to quantify segment-specific contributions of bone and muscle quality at T11–L1. Methods This retrospective cohort study analyzed 223 postmenopausal patients with single-level OVCFs at T11–L1. The severity of vertebral collapse was quantified by the sagittal area compression ratio of the fractured vertebral body (SACR-FVB). Radiological parameters including bone mineral density (BMD), trabecular CT Hounsfield units (CT Hu), vertebral bone quality (VBQ), paravertebral muscle quality (PVMQ), and fat infiltration rate (FIR) were measured. LASSO regression selected predictors; segment-specific multivariate regression and LMG variance decomposition quantified proportional contributions; RCS modeled dose-response relationships. Results CT Hu and PVMQ were identified as significant independent predictors of SACR-FVB across all three evaluated segments (P < 0.05). LMG variance decomposition revealed that CT Hu consistently accounted for the largest proportion of the explained variance across all levels (68.2% at T11, 52.7% at T12, 56.3% at L1). However, the combined contribution of paraspinal muscle parameters (PVMQ and FIR) to the explained variance reached its maximum at the L1 segment (43.7%). Furthermore, RCS analyses confirmed that the structural vulnerability of the vertebral body manifests as a continuous gradient alongside local bone attenuation and progressive muscle deterioration. Conclusions CT Hu and PVMQ were identified as significant independent predictors of vertebral collapse severity across all thoracolumbar junction segments. Localized bone quality, measured by CT Hu, remained the primary structural determinant, while the combined contribution of paraspinal muscle parameters increased caudally. Continuous quantitative monitoring of bone and muscle imaging metrics may enable early identification of high-risk patients before vertebral collapse occurs. These findings underscore the importance of a segment-specific, multidimensional approach to individualized fracture risk assessment and intervention.
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
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.
Jiaqi Jiang, Haolei Wang, Bo He et al.· Current medical imaging· 0 citations
The nomogram developed based on conventional clinical data in this study, has undergone internal validation and demonstrated efficacy in predicting NVCF following PVP, and serves as a valuable decision-making tool for clinicians.
Yiqi Wu, Qing Song, Canwei Hu et al.· Frontiers in Medicine· 0 citations
Assessment of quantitative MRI and VBQ/modified VBQ into predictive models enables opportunistic, radiation-free screening and more precise fracture risk assessment, bridging the gap between bone quantity and quality for improved prevention and management of fragility fractures.
Sanjith Manian, Arunagiri Gunasekar, Naveen Jeyaraman et al.· World Journal of Methodology· 0 citations
Study Design
Retrospective cohort study.
Purpose
To compare short- and medium-term patient-reported outcome measures (PROMs) between thoracic and lumbar percutaneous vertebroplasty (PVP) cohorts for osteoporotic vertebral compression fractures (OVCFs).
Overview of Literature
PVP is well-established for pain relief in OVCF; however, whether clinical outcomes vary by the anatomical location of the treated vertebrae, remains unclear.
Methods
Ninety patients who underwent PVP between January 2010 and August 2022 with complete 2-year PROM follow-up were included and stratified into thoracic (n=33) and lumbar (n=57) cohorts. Outcomes included the Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom score, Visual Analog Scale (VAS) pain score, and Short Form-36 (SF-36) domains. Between-group comparisons were assessed using Wilcoxon rank-sum tests, and effect sizes were summarized using Cliff's delta. Minimal clinically important difference (MCID) achievement was assessed for ODI, VAS Back Pain, and VAS Leg Pain. Multivariable linear regression examined the independent effect of vertebral region after adjustment for age, sex, race, number of vertebral levels treated, and baseline PROMs, with Benjamini-Hochberg false-discovery-rate (FDR) correction applied for multiple comparisons.
Results
The mean age was 76.4±8.5 years, and 83.3% of patients were female. No significant between-group differences were observed in ODI, NASS score, VAS pain score, or any SF-36 domain at 6 months or 2 years (p>0.05). MCID achievement rates for ODI and VAS Back Pain were high and comparable between groups at both follow-up points, exceeding 87%. On adjusted regression, the vertebral region was not an independent predictor of any postoperative PROM after FDR correction.
Conclusions
Thoracic and lumbar vertebroplasty yielded comparable 2-year PROMs with no statistically significant differences detected between cohorts. These findings suggest that the vertebral region may not be a major determinant of patient-reported recovery following vertebroplasty for OVCFs. However, residual confounding, attrition, and absent radiographic variables preclude definitive conclusions regarding clinical equivalence.
Yong Ng, Jeremy Tze En Lim, Lei Jiang et al.· Asian Spine Journal· 0 citations