Vertebral Bone Quality Score as a Predictor of Subsequent Fractures After Cement Augmentation for Osteoporotic Vertebral Compression Fracture

Neurosurgery. 2024 Nov 26. doi: 10.1227/neu.0000000000003282. Online ahead of print.

Abstract

Background and objectives: Dual-energy X-ray absorptiometry (DXA) T-scores have been shown to predict fragility fractures in population-based studies. Recently, a novel MRI-based vertebral bone quality (VBQ) score has been proposed, showing better predictability for fragility fractures compared with DXA T-scores. The aim of this study was to explore the correlation between VBQ scores and DXA T-scores and to determine the impact of VBQ scores on the risk of subsequent fragility fractures after cement augmentation for osteoporotic vertebral compression fracture (OVCF).

Methods: Between January and December 2018, 251 consecutive patients who received cement augmentation for OVCF were included in the study. VBQ scores were calculated using noncontrast T1-weighted MRI. Correlations between VBQ and T-scores were assessed. Patients were divided into 2 groups based on the presence or absence of subsequent fragility fractures after cement augmentation: (1) no Subsequent fracture group and (2) subsequent fracture group. Comparisons between the groups were conducted, and risk factors of subsequent fractures were evaluated using multivariable logistic regression analysis.

Results: Of the patients, 42 (16.7%) experienced subsequent fractures after cement augmentation. The VBQ score showed moderate correlations with the T-score of the hip (r = -0.523, P < .001) and the T-score of the lumbar spine (r = -0.383, P < .001). The subsequent fracture group had a significantly higher VBQ score (4.02 ± 0.56 vs 3.52 ± 0.62, P < .001) and a worse T-score of hip (-3.06 ± 1.28 vs -2.42 ± 0.98, P = .004). In the multivariable analysis, the VBQ score was the only independent predictor of subsequent fractures with 2.799 odds ratio (1.342 to 5.841, P = .006).

Conclusion: In patients who received cement augmentation for OVCF, the VBQ score is significantly correlated with the DXA T-score and may be a more reliable predictor of subsequent fragility fractures.