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Opportunistic Use of Lumbar Magnetic Resonance Imaging for Osteoporosis Screening

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Abstract

Summary

Magnetic resonance imaging (MRI) is a routine assessment before spine surgery. We found that the opportunistic use of MRI with the vertebral bone quality (VBQ) score has good diagnostic ability, with a threshold value of VBQ > 3.0, in recognizing patients who may need further osteoporosis evaluation.

Introduction

The purpose of this study was to determine whether the opportunistic use of magnetic resonance imaging (MRI) is useful for identifying spine surgical patients who need further osteoporosis evaluation.

Methods

This retrospective study evaluated 83 thoracolumbar spine surgery patients age ≥ 50 who received T1-weighted MRI. Opportunistic MRI was evaluated with the vertebral bone quality (VBQ) score, VBQ (fat) score, and signal-to-noise ratio (SNR). Each uses the median L1-L4 vertebral body signal intensities (SI) divided by either the L3 cerebrospinal fluid (CSF) SI, average SI of the L1 and S1 dorsal fat, or standard deviation (SD) of the background SI dorsal to the skin. Single-level VBQ was calculated as the ratio of the L1 vertebral body and L1 CSF SIs. Receiver-operator curve analysis was performed to determine diagnostic ability.

Results

The mean age was 70.10, 80% were female, and 96% were Caucasian. The mean ± SD VBQ, single-level VBQ, VBQ (fat), and SNR were 3.39 ± 0.68, 3.56 ± 0.81, 3.95 ± 1.89, and 113.18 ± 77.26, respectively. Using area under the curve, the diagnostic ability of VBQ, single-level VBQ, VBQ (fat), and SNR for clinical osteoporosis were 0.806, 0.779, 0.608, and 0.586, respectively. Diagnostic threshold values identified with optimal sensitivity and specificity were VBQ of 2.95 and single-level VBQ of 3.06.

Conclusion

Opportunistic use of MRI is a simple, effective tool that may help recognize patients who are at risk for complications related to bone disease. A VBQ > 3.0 can identify patients who need additional diagnostic evaluation.

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Data availability

The data generated and analyzed for this study are not openly available due to the datasets containing patient identifying information. The data are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Jennifer Wang for her assistance in creating the REDCap database and Scott Hetzel for his consultation on statistical methods.

Author information

Authors and Affiliations

  1. Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA

    A. Kadri & P. A. Anderson

  2. Osteoporosis Clinical Research Program, University of Wisconsin, School of Medicine and Public Health, 2870 University Ave, Suite 100, Madison, WI, 53705, USA

    N. Binkley

  3. Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53705, USA

    D. Hernando

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  1. A. Kadri
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Corresponding author

Correspondence to P. A. Anderson.

Ethics declarations

Ethics approval

The University of Wisconsin’s IRB approved this retrospective study (2019–0420-CP003).

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The study was exempt from obtaining signed informed consent.

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All authors consent to the publication of this manuscript.

Conflicts of interest

Mr. Kadri and Dr. Binkley have nothing to disclose. Dr. Hernando is a co-founder of Calimetrix, LLC. Dr. Anderson reports personal fees from Radius Medical, Amgen, and Medtronic and stock interest in Titan Spine, outside of this submitted work.

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Investigation performed at the University of Wisconsin School of Medicine and Public Health.

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Kadri, A., Binkley, N., Hernando, D. et al. Opportunistic Use of Lumbar Magnetic Resonance Imaging for Osteoporosis Screening. Osteoporos Int 33, 861–869 (2022). https://doi.org/10.1007/s00198-021-06129-5

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  • DOI: https://doi.org/10.1007/s00198-021-06129-5

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