Aug 2026· Journal of Magnetic Resonance Imaging· 1 citation· 47 references
Medicine
Abstract
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).
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.
Jiaqi Jiang, Haolei Wang, Bo He et al.· Current medical imaging· 0 citations
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.
Yi-tao Liao, Xingguo Zhang, Xuanyu Xie et al.· Frontiers in Endocrinology· 0 citations
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
Most vertebral fractures are asymptomatic and remain underdiagnosed. Vertebral Fracture Assessment (VFA) by Dual-energy X-ray Absorptiometry (DXA) enables low-radiation detection of morphometric vertebral fractures (MVFs). The present study estimated the prevalence of MVFs in Spanish adults aged ≥40 years and characterized affected individuals.
METHODS
This multicenter cross-sectional study included 1082 adults (aged 40-80 years) from 15 primary care centers across six Spanish provinces. VFA was performed using a mobile DXA unit (Hologic® Horizon W). Two rheumatologists independently evaluated vertebrae T5-L4 using Genant's method; discrepancies were resolved by consensus. Bone mineral density (BMD) and clinical data were recorded. Primary care physicians reviewed records and imaging to classify MVFs as clinical fragility (CFVFs), traumatic, or morphometric-only.
RESULTS
244 MVFs were identified in 171 participants (15.9%; 95% CI, 13.8-18.2). MVFs were more frequent in men (19.3% vs 12.5%), older individuals, and those with prior non-vertebral fragility fractures, lower hip BMD, or osteoporosis (all p < 0.01). Most were grade 1 (62.7%), anterior (79.9%), and located at the thoracolumbar junction. After review, 52 participants (4.8%) had CFVFs, 19 traumatic fractures, and 100 morphometric fractures. CFVFs were mainly grade 2, anterior, and thoracolumbar. They occurred more often in older women and were associated with previous nonvertebral fragility fractures.
CONCLUSIONS
MVFs affected nearly one in six Spanish adults aged ≥40 years, and were independently associated with male sex, older age, and lower hip BMD. CFVFs represented a smaller, underdiagnosed subset and were more frequent in older women, with distinctive severity and localization patterns.
C. Gómez-Vaquero, Jordi Fiter Aresté, M. Domínguez-Álvaro et al.· Bone· 0 citations
Objectives Osteoporotic vertebral compression fractures (OVCFs) are a major health burden, especially with aging populations. While percutaneous vertebroplasty (PVP) is effective, new vertebral compression fractures (NVCFs) are a common complication. Current NVCF prediction models focus on cement factors or bone density alone, ignoring the critical role of paraspinal muscles. To address this gap, our study integrates preoperative CT imaging of bone density and muscle area with clinical data to develop a visualized early prediction model for NVCF risk, aiming to improve patient outcomes. Methods A total of 423 patients who underwent PVP at Guangzhou University of Chinese Medicine Dongguan hospital were retrospectively analyzed and were allocated into a training set and a validation set in an 8:2 ratio. The study employed multivariate logistic regression analysis and the Least Absolute Shrinkage and Selection Operator (Lasso) to develop predictive models and generate nomogram. Receiver Operating Characteristic (ROC) curves and calibration curves were plotted to evaluate the models’ discriminatory and calibration capabilities, Decision Curve Analysis (DCA) and Clinical Impact Curve(CIC)were used to assess the models’ clinical applicability and utility. Results Lasso regression analysis identified age, albumin (ALB), paravertebral muscle area, bone CT value, low-energy trauma, and single-segment fracture as significant predictors. AUC of the nomogram model in the training set was 0.893 (95% CI: 0.858–0.928) and in the validation set was 0.952 (95% CI: 0.903–1), demonstrating its robust predictive capability. DCA and CIC further suggest that this nomogram model possesses substantial clinical application value. Conclusion The nomogram developed based on conventional clinical data in this study, has undergone internal validation and demonstrated efficacy in predicting NVCF following PVP. It serves as a valuable decision-making tool for clinicians. However, further multicenter studies are required for external validation to confirm its generalizability.
Yiqi Wu, Qing Song, Canwei Hu et al.· Frontiers in Medicine· 0 citations
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.