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.
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.
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
The equal categorization of fractures 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.
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
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.
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.
