Cross Sectional Magnetic Resonance Imaging-Based Vertebral Bone Quality Score and Dual-Energy X-Ray Absorptiometry Bone Mineral Density Measurement in Post Menopausal Women in South Indian Population with or Without Fragility Fracture

Assessment of Osteoporotic Fracture Risk in Patients above 50 Years Using Quantitative Ultrasonography and Fracture Risk Assessment Tool: A Cross-sectional Study

Abstract Introduction: To investigate the prevalence of osteoporosis and its association with age, sex, body mass index (BMI), and bone mineral density (BMD) in a sample of individuals from South India. To assess the risk of major osteoporotic fractures (MOF) and hip fractures among study participants. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in Southern India. A sample of 453 participants both male and female above 50 years of age was included. BMD measurements were assessed using the ultrasound bone densitometer. BMI and fracture risk assessment (FRAX) score were calculated for all patients. Results: The average age of the participants was 60 years. The mean t-score was −1.57. 306 (68%) had osteopenia, and 45 (9.9%) participants had osteoporosis. A higher number of females (73%) had osteoporosis than males (27%). There was no significant difference between the BMI in the normal (28.16) versus the osteopenia (27.67) and the osteoporotic group (26.92). Mean MOF risk was 4.03 (2.81 SD). Conclusion: Decrease in BMD was associated with increased fracture risk, particularly among older female participants. The findings underscore the need for targeted public health interventions and clinical strategies to improve bone health and reduce fracture risk.

Fracture risk prediction based on multivariable diagnostic models incorporating dual-energy X-ray absorptiometry based bone mineral density, trabecular bone score, and clinical risk factors in women aged ≥ 50 years: a prospective study

According to the available reports, there is a major treatment gap in the management of osteoporotic fractures in Poland. It is crucial to identify those at high risk of low-energy fractures who ought to be treated. The study aimed to assess the diagnostic value of dual-energy X-ray absor­ptiometry (DXA) and the DXA-derived trabecular bone score (TBS) in fracture risk prediction in Polish women ≥ 50 years of age at risk of osteoporosis. Additional measures included the analysis of how incorporating other risk factors may improve the fracture prediction model. From a database of 5,000 randomly selected women, a total of 411 women aged ≥ 50 years were finally included – those who had a DXA examination followed by a complete medical questionnaire performed. After 5–9 years of observation, participants completed a follow-up questionnaire similar to the baseline questionnaire. In addition, TBS analysis was performed retrospectively using lumbar spine DXA scans. Then their fracture risk was calculated using the FRAX algorithm. Most patients with osteoporotic fractures were in a group with a degraded bone microarchitecture and a diagnosis of osteoporosis. Fracture patients without osteoporosis (T-score > –2.5) were mostly (73%) characterised by a partially or significantly degraded bone microarchitecture. The highest predictive value (AUC 0.6) was observed in relation to the models FRAX BMD and FRAX BMD-TBS (p < 0.05), which included both skeletal and other clinical risk factors. Also, the outcomes for all other analysed models (FRAX BMI + TBS, FRAX BMD + TBS, FRAX BMI + BMD spine + TBS) were statistically significant. Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland. Further studies on fracture prediction models in patients with osteopenia are required.

The association between bone density evaluated on CT or MRI versus the gold standard dual-energy X-ray absorptiometry (DEXA) in the lumbar spine and hip: a meta-analysis

Introduction CT-based Hounsfield units (HU) and MRI-based vertebral bone quality (VBQ)-scores are opportunistic markers of bone mineral density and potential alternatives for dual-energy X-ray absorptiometry (DEXA). Research question What is the correlation between HU values and VBQ-scores in relation to DEXA, and what is the corresponding area-under-the-curve (AUC)-based diagnostic discrimination to detect osteopenia and osteoporosis? Material and methods PubMed, Embase, Web of Science, Cochrane Library, and CINAHL were searched through August 2025 for studies reporting correlations between DEXA and CT and/or MRI or the AUC-based diagnostic discrimination of CT and/or MRI to detect osteopenia and osteoporosis. Random effects models were used to calculate pooled correlation coefficients and AUC values along with 95% confidence intervals. Results Forty-three studies, including 8222 patients, were analyzed. HU demonstrated stronger correlations with DEXA T-scores than the VBQ-score (maximum correlation coefficient: 0.741 (95% CI: 0.578-0.847) vs. −0.476 (95% CI: −0.548 to −0.398) and greater AUC-based diagnostic discrimination for osteopenia and osteoporosis (maximum AUC: 0.875 (95% CI: 0.841-0.909) vs. 0.806 (95% CI: 0.684-0.929) across all vertebrae and DEXA sites. Correlation and AUC-based diagnostic discrimination of HU were consistent across vertebrae, with slightly better results at L2 and the mean of L1–L4. VBQ-score correlations were highest at L1 and gradually decreased from L1 to L4. Discussion and conclusion When CT is available, HU appears to be the better-supported opportunistic marker for low BMD than VBQ. All vertebrae demonstrated comparable correlation and AUC-based diagnostic discrimination, with L2 HU and the mean of L1-L4 HU showing slightly superior results.

Routine MRI for opportunistic osteoporosis screening: diagnostic accuracy of vertebral bone quality and a novel femoral bone quality score compared with DXA.

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.

The osteoporosis care cascade in postmenopausal women with and without cardiovascular disease: a nationally representative cross-sectional study using dual-energy X-ray absorptiometry

Calcaneal quantitative ultrasonometry as a field-friendly tool for bone quality assessment in Italian postmenopausal women: Associations with body composition and menopausal duration

Background: In postmenopausal women, bone quality assessment is essential for identifying skeletal fragility risk. The calcaneal bone quality index (BQI), assessed via quantitative ultrasound (QUS), represents a non-invasive, field-friendly alternative to dual-energy X-ray absorptiometry (DXA). Objective: To investigate the associations between BQI, body composition, menopausal duration and functional variables in Italian postmenopausal women. Subjects and methods: A cross-sectional study design – in which all measurements were taken at a single point in time – was conducted on 138 Italian postmenopausal women (mean age: 61.1±5.3 years; mean years since menopause (YSM): 10.5±6.1 years). BQI was assessed using calcaneal QUS (SONOST 3000). Body composition was assessed through bioelectrical impedance analysis (BIA 101, Akern), providing fat-free mass (FFM), fat mass (FM) and fat percentage (%F). Handgrip strength (HGS) was measured bilaterally using a dynamometer. Pearson correlations and two multiple linear regression models were performed using BQI as the dependent variable: a background model (age, YSM, BMI) and a body composition model (%F, FFM, HGS). A simple linear regression with YSM alone was also conducted. Results: BQI showed significant negative correlations with age (r=-0.30, p=0.0003) and YSM (r=-0.34, p<0.0001), and positive correlations with BMI, FFM and FM (r=0.18 for all, p=0.033). No significant correlations emerged for %F and HGS. The body composition model was not statistically significant (F=1.864, R²=0.040, p=0.139), whereas the background model was statistically significant (F=7.133, R²=0.138, p=0.0002), with YSM as the strongest predictor (p<0.0001). In simple linear regression, YSM alone explained 12% of BQI variance (R²=0.120, p<0.0001). Conclusions: Menopausal duration is the primary determinant of calcaneal bone quality in postmenopausal women, independent of body composition. These findings support the use of calcaneal QUS as a field-friendly pre-screening tool for bone quality monitoring in non-clinical and large-scale epidemiological settings.