Magnetic Resonance Imaging–Based Vertebral Bone Quality Score as a Comprehensive Indicator to Evaluate the Trend of Bone Turnover Markers

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: This study aimed to analyze the correlation between vertebral bone quality (VBQ) scores and bone turnover markers (BTMs) in lumbar spine disorders. BACKGROUND: VBQ score is increasingly used in the assessment of bone mineral density (BMD), and bone quality profiles are closely related to bone metabolism. However, the level of bone turnover is often overlooked in clinical practice. PATIENTS AND METHODS: We retrospectively analyzed the data from 234 patients who underwent lumbar spine surgery. VBQ scores were evaluated using preoperative lumbar T1-weighted magnetic resonance imaging, with patients classified into high (>3.3), middle (2.7 to 3.3), and low (<2.7) VBQ groups. The data of computed tomography images and dual-energy x-ray absorptiometry were collected to obtain the Hounsfield unit (HU) and T value. Correlation analysis, linear regression, and 1-way ANOVA were used to analyze the relationship between BTMs, including parathyroid hormone (ng/L), 25-hydroxyvitamin D3 (nmol/L), osteocalcin (ng/mL), β-CrossLaps (ng/mL), and procollagen type I N-propeptide (ng/mL) and bone quality. P <0.05 was considered statistically different. RESULTS: Comparative analysis showed BTMs varied markedly across VBQ categories ( P < 0.0001 to P = 0.0158), with osteoblast-related markers [25-hydroxyvitamin D3, OC] decreasing and osteoclast-related markers (β-CrossLaps) increasing with higher VBQ scores. Multivariate analysis confirmed age, sex, BMI, and specific BTMs (except for PINP) as independent predictors of VBQ scores ( P = 0.0075 to 0.0256). VBQ demonstrated superior correlations with BTMs ( r = 0.52 to 0.63) compared with T-scores and HU values, highlighting its enhanced sensitivity to dynamic bone metabolism. Notably, patients with normal BMD/high HU but intermediate VBQ scores showed suppressed osteoblastic activity ( P = 0.0009 to 0.0036), while those with osteopenia-level BMD/HU and elevated VBQ scores exhibited exacerbated bone resorption ( P < 0.001). CONCLUSION: This is the first study to link VBQ scores with BTMs in lumbar spine patients. Preoperative VBQ assessment through magnetic resonance imaging can initially evaluate bone metabolism without radiation exposure, guiding osteoporosis treatment post-surgery to optimize bone health. LEVEL OF EVIDENCE: Level III.