Comparative Evaluation of MRI-Based Vertebral Bone Quality Score and DXA in Osteoporosis Assessment

The vertebral bone quality (VBQ) score is a novel MRI-based parameter that enables radiation-free assessment of bone quality. This study aimed to investigate the relationship between VBQ and DXA scores and to assess the diagnostic performance of VBQ for osteoporosis detection. This retrospective study included 465 patients (276 women, 189 men; mean age 60.7 ± 11.8 years) who underwent both lumbar MRI and DXA. VBQ scores were obtained from midsagittal T1-weighted images as the ratio of vertebral signal intensity to cerebrospinal fluid signal. Correlations between VBQ, DXA T-scores, and clinical variables were analyzed. Diagnostic performance was evaluated using ROC analysis. VBQ scores increased progressively with bone loss severity. Mean VBQ values were significantly higher in osteopenic (3.25 ± 0.70) and osteoporotic (3.26 ± 0.67) patients compared with those with normal BMD (3.01 ± 0.65, p = 0.041). VBQ was negatively correlated with DXA T-scores (r = − 0.237, p < 0.001) and BMI (r = − 0.129, p = 0.006), and positively correlated with age (r = 0.139, p = 0.003). ROC analysis showed that VBQ could distinguish osteoporotic from non-osteoporotic patients with an AUC of 0.612 (95% CI, 0.531–0.693). Intra- and interobserver agreement were excellent (ICC = 0.91 and 0.90, respectively). VBQ is significantly correlated with DXA-derived BMD and clinical parameters. Although not a standalone diagnostic tool, VBQ may serve as a valuable adjunct for comprehensive bone quality assessment using routine MRI.