Sep 2026· World Journal of Methodology· Vol 16 3, pp.
117490
· 0 citations· 84 references
Medicine
TL;DR
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.
Abstract
Fragility fractures represent a significant global health burden, with osteoporosis affecting over 500 million individuals and contributing to nearly 9 million fractures annually. Conventional diagnosis relies on dual-energy X-ray absorptiometry (DEXA) to measure bone mineral density (BMD), yet BMD alone explains only part of fracture risk. Many fractures occur in patients without osteoporosis by DEXA criteria, underscoring the limitations of bone quantity-based assessment. Advances in imaging and biomarker research highlight the importance of bone quality, microarchitecture, and marrow composition in fracture prediction. Quantitative magnetic resonance imaging (MRI) techniques - including T1ρ, T2 mapping, proton density fat fraction, and diffusion-weighted imaging - offer non-invasive insights into collagen integrity, proteoglycan content, water distribution, and marrow adiposity. These parameters correlate with trabecular deterioration and cortical porosity, enhancing risk stratification beyond BMD. Similarly, Vertebral Bone Quality (VBQ) scoring, derived from routine T1-weighted MRI, provides a practical surrogate for bone quality by quantifying vertebral marrow signal intensity relative to cerebrospinal fluid. Modified VBQ improves accuracy by minimising posterior vertebral artefacts, demonstrating stronger correlation with DEXA T scores and trabecular microarchitecture. Studies show VBQ predicts vertebral fragility fractures independently of BMD, with sensitivity exceeding 90% and discriminatory ability comparable to the fracture risk assessment tool and trabecular bone score. Integration of quantitative MRI and VBQ/modified VBQ into predictive models, supported by artificial intelligence, enables opportunistic, radiation-free screening and more precise fracture risk assessment. Together, these advanced imaging biomarkers represent a paradigm shift toward comprehensive evaluation of bone strength, bridging the gap between bone quantity and quality for improved prevention and management of fragility fractures.
Study Design
Retrospective sex- and age-matched case-control study.
Purpose
To assess bone mineral density (BMD)-trabecular bone score (TBS) discordance and high-burden abdominal aortic calcification (AAC) in patients with radiographically confirmed osteoporotic vertebral compression fracture (OVCF).
Overview of Literature
Conventional BMD thresholds may fail to identify all patients with vertebral skeletal fragility, as vertebral fractures can occur despite nonosteoporotic BMD. TBS complements BMD by evaluating trabecular microarchitecture, while AAC may serve as a marker of systemic bone-vascular health associated with skeletal fragility.
Methods
This retrospective sex- and age-matched case-control study enrolled patients aged ≥50 years who underwent dual-energy X-ray absorptiometry (DXA) with TBS assessment and vertebral imaging. OVCF was defined as a Genant grade 2 or 3 vertebral fracture. The primary cohort included 47 OVCF patients and 188 matched controls. BMD T-scores at the lumbar spine, femoral neck, total hip, TBS, and AAC-24 were evaluated. Matched conditional logistic regression was used to determine associations with OVCF.
Results
More than half of OVCF patients did not demonstrate osteoporotic BMD at any measured DXA site (53.2%). Among those with nonosteoporotic BMD, low TBS was more common in cases than in controls (48.0% vs. 22.7%). Low TBS remained independently associated with OVCF after adjusting for the lowest BMD T-score and high-burden AAC (odds ratio, 2.66; 95% confidence interval, 1.25-5.63; p =0.011). High-burden AAC was more frequent among cases, although its association was attenuated after adjustment.
Conclusions
Low TBS may aid in identifying vertebral skeletal fragility in OVCF patients with nonosteoporotic BMD on conventional DXA. High-burden AAC may provide vascular information, although its incremental association beyond BMD and TBS was attenuated.
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.
M. Müller, João Paulo Colhado Ferreira, Laura Mulazzani Minuzzi Macedo et al.· Skeletal Radiology· 0 citations
PURPOSE
Bone mineral density (BMD) alone is insufficient to fully capture fracture risk. This study investigated the association between lumbar spine BMD (LS-BMD) and trabecular bone score (TBS) and constructed age- and sex-specific centile reference curves for both measures in a Taiwanese population.
METHODS
This cross-sectional study included 1,196 participants. LS-BMD was measured at L1-L4 by dual-energy X-ray absorptiometry (DXA), and TBS was derived from the same images using TBS iNsight software (Med-Imaps). Pearson correlation and multiple linear regression were performed to examine BMD-TBS associations and identify predictors of TBS variation. Generalized Additive Models for Location, Scale and Shape (GAMLSS) with cubic spline smoothing was applied separately by sex to generate continuous age-specific centile curves (5th-95th percentiles) for ages 20-90 years.
RESULTS
The cohort comprised 530 (44.3%) participants with normal BMD, 493 (41.2%) with osteopenia, and 173 (14.5%) with osteoporosis. LS-BMD and TBS were positively correlated (r = 0.68). LS-BMD, BMI, and age were significant independent predictors of TBS (adjusted R² = 0.672); menopausal status was not. GAMLSS centile curves revealed that female LS-BMD peaked at ages 30-40 years and declined sharply after age 50, while male upper BMD centiles remained stable despite concurrent TBS decline, a BMD-TBS dissociation undetectable by mean-based analyses.
CONCLUSION
LS-BMD and TBS provide complementary information on bone quantity and microarchitectural integrity. The sex-specific GAMLSS-derived centile curves constitute the first full-distribution normative reference standards for LS-BMD and TBS in a Taiwanese population, extending beyond conventional T-score classification.
Li-Chuan Huang, Li-Guo Chen, Ping-An Wu et al.· Journal of clinical densitom...· 0 citations
Background: The prevalence of osteoporosis in postmenopausal women is one out of every three women, according to
recent studies. Awareness and management of osteoporosis are underrated. Objective: This cross-sectional study aimed to
emphasise the importance of early detection of osteoporosis in post menopausal females. Methodology: In the present
study, 70 Postmenopausal women (35 women with and 35 women without fracture fragility) who fulfilled the inclusion
criteria were enrolled. A MRI and DEXA-based VBQ score was analyzed for all the particupating individuals. It was
observed that the correlation exibhit between these two scores. Results: The observation found an individual age of 67.6
years, T-scores mean of 1.9, Z-scores of -0.6, and VBQ scores of 3.4, determining bone density in osteoporotic
individuals. These outcomes explains the need for early osteoporosis detection to evade the chances of fractures. The
VBQ-fracture correlation análisis determines its value is complementing DEXA for upgraded osteoporosis risk detection.
Discussion: The current study revealed significant vertebral fracture categorization in older adults. The equal
categorization of fractures (50%) and their improved correlation with signal intensity radiating pain VBQ scores and
DEXA scores indicate that these variables may be useful in predicting fracture risk. Conclusion: These results highlight
the need for a thorough method that incorporates imaging bone density measurements and clinical indicators in order to
determine fractures.
Udaya Shankar S R, Sree Shangamithra, Vishal Sirohi et al.· International Journal of Dru...· 0 citations
Bone fragility has traditionally been associated with osteoporosis and reduced bone mineral density; however, contemporary evidence indicates that fracture risk is influenced by a broader spectrum of metabolic, nutritional, endocrine, inflammatory, and musculoskeletal factors. The objective of this review was to analyze the metabolic determinants associated with bone fragility beyond osteoporosis and to examine their influence on fracture risk and recovery outcomes. A structured narrative review of scientific literature published in major biomedical databases was conducted, focusing on diabetes mellitus, chronic kidney disease, vitamin D deficiency, malnutrition, osteosarcopenia, endocrine dysfunction, and chronic inflammation. The findings demonstrated that these conditions contribute significantly to alterations in bone quality, remodeling capacity, muscle performance, and tissue repair, thereby increasing susceptibility to fragility fractures independently of bone mineral density measurements. Diabetes mellitus and chronic kidney disease emerged as major determinants of skeletal fragility due to their effects on collagen integrity, mineral metabolism, vascular function, and bone turnover. Nutritional deficiencies and inadequate vitamin D status were consistently associated with impaired mineralization, increased fall risk, and delayed fracture healing. Furthermore, osteosarcopenia highlighted the close biological relationship between bone and muscle health and its contribution to fracture susceptibility and functional decline. The evidence supports a multidimensional understanding of skeletal fragility that incorporates metabolic health into fracture prevention and management strategies. Expanding fracture risk assessment beyond traditional osteoporosis models may improve early identification of vulnerable individuals and facilitate more comprehensive approaches to prevention, treatment, and rehabilitation.
Mario René López Monzón, Ricardo Harold Flores Arotinco, Nathalia Alejandra Montaño Argote et al.· IECCMEXICO· 0 citations
INTRODUCTION:
Osteoporosis manifestations in the context of malabsorption syndrome result from impaired intestinal micronutrient absorption, representing a significant challenge in pediatric practice. While various modalities exist, dual-energy X-ray absorptiometry offers distinct advantages over ultrasound densitometry or quantitative computed tomography. Interpreting osteoporosis and osteoporotic fracture risk in children is particularly complex due to the often oligosymptomatic presentation and the limited availability of robust pediatric diagnostic criteria. Low-energy fractures, a major complication, significantly diminish quality of life and contribute to premature disability. Early identification of risk factors, coupled with timely prophylactic and therapeutic interventions, is crucial for improving long-term outcomes in this growing population.
OBJECTIVE:
To refine the interpretive algorithm for dual-energy X-ray absorptiometry (DXA) reports in a pediatric cohort.
MATERIALS AND METHODS:
Bone mineral density (BMD) and bone mineral content (BMC) serve as the principal surrogate markers for assessing bone health. Clinical screening for osteoporosis fundamentally relies on quantifying these parameters. For this analysis, we selected DXA scan protocols for total body less head (TBLH) and the lumbar spine (L
II
–L
IV
). The study cohort comprised 98 pediatric patients with gastroenterological conditions. Indications for DXA evaluation included: chronic oral corticosteroid therapy (>3 months duration, >5 mg/day), delayed puberty, a history of two or more long bone fractures by age 10, prior administration of zoledronic acid, and conditions associated with intestinal malabsorption. Assessment of bone metabolism included the Z‑score and individual quantitative BMD (g/cm
2
).
RESULTS:
When employing a rigorous, standardized acquisition protocol coupled with patient-specific interpretation of ageand sex-appropriate reference data, DXA provides clinicians with enhanced diagnostic capability. This approach facilitates accurate baseline assessment of bone mineral status and enables sensitive monitoring of longitudinal changes, thereby guiding therapeutic management in this vulnerable population.
DISCUSSION:
It is important to emphasize that the examination protocol has been methodically validated in children aged 5–17 years. Nevertheless, the procedural specifics and interpretation of results in patients younger than 5 years warrant further investigation and methodological refinement to improve the accuracy of data analysis.
CONCLUSION:
Adopting a personalized analytical approach minimizes the risk of overdiagnosis and allows for precise identification of the baseline value for longitudinal monitoring of bone mineral density (BMD) accumulation, including quantitative follow‑up assessments. Standardization of the analytical framework in densitometric studies not only facilitates BMD evaluation but also enables assessment of bone metabolism quality and prevention of potential complications.
E. A. Melnikova, M. Redkina, K. K. Panuntseva et al.· Diagnostic radiology and rad...· 0 citations
A new method for surgically removing training examples from a model reveals that as datasets grow, the link between what a model learns and what it produces dissolves.
