The Role of Lumbar Spine Magnetic Resonance Imaging-Based Scoring and Quantitative Assessment in the Diagnosis of Osteoporosis

Objective: Osteoporosis is a major cause of morbidity and mortality that can lead to fractures as a result of a decrease in bone mineral density (BMD) and bone quality. This study aimed to determine the role of lumbar magnetic resonance imaging (MRI)-based scoring and quantitative assessment in diagnosing osteoporosis, a condition characterized by decreased BMD and increased risk of fractures. Methods: A retrospective analysis was performed on postmenopausal Turkish women who underwent both lumbar MRI and dual-energy X-ray absorptiometry (DXA) for low back pain between January 2023 and July 2024. A control group of healthy women aged 20-29 years was also included for MRI scoring. Signal-to-noise ratios (SNR) were calculated from T1-weighted MRI sequences. Receiver operating characteristic (ROC) analyses were performed to evaluate the relationship between MRI findings and DXA T-scores. Results: A notable inverse correlation was identified between intravertebral T1 signal intensity and T-score, whereas no significant correlation was observed between T2 signal intensity and T-score. The M-score, derived from MRI SNR, exhibited a cutoff value of 0.5, with 87.0% sensitivity and 76.0% specificity for differentiating osteoporotic from non-osteoporotic patients. The area under the ROC curve was 0.881 (95% confidence interval: 0.830-0.933), indicating robust diagnostic performance. Conclusion: T1-weighted imaging is a promising, noninvasive surrogate marker that can be used as a screening tool for osteoporosis. The use of lumbar MRI may help identify patients who require further DXA examinations, potentially optimizing clinical pathways.