Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of MRI‑based vertebral bone quality scores in elderly patients with vertebral fragility fractures

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Objective

To explore the characteristics of vertebral bone quality (VBQ) scores in patients with vertebral fragility fractures, including VBQ score and single-level VBQ score, and evaluate their effectiveness as predictors.

Methods

The VBQ scores were measured using T1-weighted MRI images. VBQ scores were compared in patients with different times of previous fragility fractures. In addition, patients with fractures were matched for age and sex with patients without fractures, and VBQ scores were compared between the two groups. Finally, the predictive efficiency of VBQ scores for vertebral fragility fractures was analyzed by the receiver-operator curve (ROC).

Results

The average VBQ score and single-level VBQ score in patients with fractures were 3.48 ± 0.56 and 3.60 ± 0.60 and no difference among patients with different times of previous fractures. As for the age- and sex-matched patients, fracture patients had higher VBQ scores (VBQ score: 3.48 ± 0.56 vs. 2.88 ± 0.40, p < 0.001; single-level VBQ score: 3.60 ± 0.60 vs. 2.95 ± 0.44, p < 0.001). The AUCs using the VBQ score and single-level VBQ score to predict fragility fractures were 0.815 and 0.817, respectively. The optimal thresholds of the VBQ score and single-level VBQ score for predicting fragility fractures were 3.22 and 3.16, respectively.

Conclusion

MRI‑based VBQ scores are important predictors of vertebral fragility fracture but have no predictive value for the recurrence of fractures in patients with a history of fragility fractures. The VBQ score of 3.22 and single-level VBQ score of 3.16 are optimal thresholds that can be used when using lumbar MRI scans to identify individuals at high risk for fragility fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data are not publicly available due to containing patient privacy. Data may be obtained from the corresponding author on reasonable request.

References

  1. Cheng X, Zhao K, Zha X et al (2021) Opportunistic screening using low-dose CT and the prevalence of osteoporosis in China: a nationwide multicenter study. J Bone Miner Res 36(3):427–435. https://doi.org/10.1002/jbmr.4187

    Article  CAS  PubMed  Google Scholar 

  2. Compston JE, Mcclung MR, Leslie WD (2019) Osteoporosis. Lancet 393(10169):364–376. https://doi.org/10.1016/s0140-6736(18)32112-3

    Article  CAS  PubMed  Google Scholar 

  3. Yu F, Xia W (2019) The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos 14(1):32. https://doi.org/10.1007/s11657-018-0549-y

    Article  PubMed  Google Scholar 

  4. Muraki S, Yamamoto S, Ishibashi H et al (2004) Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 15(9):724–728. https://doi.org/10.1007/s00198-004-1600-y

    Article  PubMed  Google Scholar 

  5. Schuit SC, Van Der Klift M, Weel AE et al (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone 34(1):195–202. https://doi.org/10.1016/j.bone.2003.10.001

    Article  CAS  PubMed  Google Scholar 

  6. Lee SJ, Binkley N, Lubner MG et al (2016) Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int 27(3):1131–1136. https://doi.org/10.1007/s00198-015-3318-4

    Article  CAS  PubMed  Google Scholar 

  7. Anderson PA, Polly DW, Binkley NC et al (2018) Clinical use of opportunistic computed tomography screening for osteoporosis. J Bone Joint Surg Am 100(23):2073–2081. https://doi.org/10.2106/jbjs.17.01376

    Article  PubMed  Google Scholar 

  8. Zou D, Li W, Deng C et al (2019) The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J 28(8):1758–1766. https://doi.org/10.1007/s00586-018-5776-9

    Article  PubMed  Google Scholar 

  9. Schreiber JJ, Anderson PA, Rosas HG et al (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 93(11):1057–1063. https://doi.org/10.2106/jbjs.J.00160

    Article  PubMed  Google Scholar 

  10. Lee SJ, Graffy PM, Zea RD et al (2018) Future osteoporotic fracture risk related to lumbar vertebral trabecular attenuation measured at routine body CT. J Bone Miner Res 33(5):860–867. https://doi.org/10.1002/jbmr.3383

    Article  CAS  PubMed  Google Scholar 

  11. Zou D, Ye K, Tian Y et al (2020) Characteristics of vertebral CT Hounsfield units in elderly patients with acute vertebral fragility fractures. Eur Spine J 29(5):1092–1097. https://doi.org/10.1007/s00586-020-06363-1

    Article  PubMed  Google Scholar 

  12. Ehresman J, Pennington Z, Schilling A et al (2020) Novel MRI-based score for assessment of bone density in operative spine patients. Spine J 20(4):556–562. https://doi.org/10.1016/j.spinee.2019.10.018

    Article  PubMed  Google Scholar 

  13. Ehresman J, Schilling A, Yang X et al (2021) Vertebral bone quality score predicts fragility fractures independently of bone mineral density. Spine J 21(1):20–27. https://doi.org/10.1016/j.spinee.2020.05.540

    Article  PubMed  Google Scholar 

  14. Haffer H, Muellner M, Chiapparelli E et al (2022) Bone quality in patients with osteoporosis undergoing lumbar fusion surgery: analysis of the MRI-based vertebral bone quality score and the bone microstructure derived from microcomputed tomography. Spine J 22(10):1642–1650. https://doi.org/10.1016/j.spinee.2022.05.008

    Article  PubMed  Google Scholar 

  15. Salzmann SN, Okano I, Jones C et al (2022) Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion. Spine J 22(8):1301–1308. https://doi.org/10.1016/j.spinee.2022.03.006

    Article  PubMed  Google Scholar 

  16. Kadri A, Binkley N, Hernando D et al (2022) Opportunistic use of lumbar magnetic resonance imaging for osteoporosis screening. Osteoporos Int 33(4):861–869. https://doi.org/10.1007/s00198-021-06129-5

    Article  CAS  PubMed  Google Scholar 

  17. Pickhardt PJ, Pooler BD, Lauder T et al (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158(8):588–595. https://doi.org/10.7326/0003-4819-158-8-201304160-00003

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim AYE, Lyons K, Sarmiento M, et al (2022) MRI-based score for assessment of bone mineral density in operative spine patients. Spine (Phila Pa 1976). https://doi.org/10.1097/brs.0000000000004509

  19. Li R, Yin Y, Ji W et al (2022) MRI-based vertebral bone quality score effectively reflects bone quality in patients with osteoporotic vertebral compressive fractures. Eur Spine J 31(5):1131–1137. https://doi.org/10.1007/s00586-022-07177-z

    Article  PubMed  Google Scholar 

  20. Schilling AT, Ehresman J, Pennington Z et al (2021) Interrater and intrarater reliability of the vertebral bone quality score. World Neurosurg 154:e277–e282. https://doi.org/10.1016/j.wneu.2021.07.020

    Article  PubMed  Google Scholar 

  21. Ehresman J, Schilling A, Pennington Z et al (2019) A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurg Spine 32:499–506. https://doi.org/10.3171/2019.9.Spine19954

    Article  Google Scholar 

  22. Graffy PM, Lee SJ, Ziemlewicz TJ et al (2017) Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol 209(3):491–496. https://doi.org/10.2214/ajr.17.17853

    Article  PubMed  Google Scholar 

  23. Gawel SH, Davis GJ, Luo M et al (2020) Serum biomarkers that predict lean mass loss over bed rest in older adults: an exploratory study. Clin Chim Acta 509:72–78. https://doi.org/10.1016/j.cca.2020.06.003

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to all study participants for their participation in the study.

Funding

None of the authors received funding from other individuals or institutions.

Author information

Author notes

  1. Wenshuai Li and Houze Zhu have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Wenshuai Li, Houze Zhu, Junchuan Liu, Hongsen Tian, Jia Li & Linfeng Wang

  2. The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China

    Wenshuai Li, Houze Zhu, Junchuan Liu, Hongsen Tian, Jia Li & Linfeng Wang

Authors
  1. Wenshuai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Houze Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junchuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hongsen Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Linfeng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WL and HZ equally participated in data collection and article writing. JL participated in data collection. HT participated in statistical analysis. JL participated in the language editing. LW participated in the design of the study and the revision of the manuscript. All authors read and approve the final version of the manuscript.

Corresponding author

Correspondence to Linfeng Wang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Consent for publication

Not applicable.

Ethical approval

The study was approved by the ethical committee of The Third Affiliated Hospital of Hebei Medical University. In the study, the need for written informed consent was waived by the ethical committee of The Third Affiliated Hospital of Hebei Medical University due to the retrospective nature of the study. All methods were carried out by relevant guidelines and regulations.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, W., Zhu, H., Liu, J. et al. Characteristics of MRI‑based vertebral bone quality scores in elderly patients with vertebral fragility fractures. Eur Spine J 32, 2588–2593 (2023). https://doi.org/10.1007/s00586-023-07744-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07744-y

Keywords

Search

Navigation