Utility of magnetic resonance imaging–based vertebral bone quality score in recognizing patients at risk for secondary fracture after vertebroplasty

OBJECTIVE The objective of this study was to determine whether the vertebral bone quality (VBQ) score could identify, among patients undergoing vertebroplasty and having probable low bone mineral density, those who were at risk for secondary fracture. METHODS In this retrospective study, the authors evaluated the medical records of patients with a compression fracture who had undergone vertebroplasty and had preprocedural T1-weighted MRI from January 2016 to January 2021. VBQ scores were calculated as the quotient of the median signal intensity from the L1 to L4 vertebral bodies divided by the signal intensity of L3 cerebrospinal fluid on T1-weighted imaging. A high VBQ score was defined as ≥ 3.0, with receiver operating characteristic curve analysis performed to verify this threshold. Secondary fracture included a fracture at any site after the index vertebroplasty procedure. Time-to-event analysis was performed to determine secondary fracture occurrence. RESULTS Among 60 patients eligible for the study, the mean time to follow-up was 25.7 ± 15.4 months (mean ± standard deviation), age was 73.65 ± 10.1 years, BMI was 28.93 ± 6.7, and 57% of the patients were female. The mean VBQ score excluding the lumbar fracture level was 3.44 ± 0.82, which was not significantly different from the mean VBQ score including the fracture level (3.40 ± 0.84; p = 0.401). Secondary fracture occurred in 33.3% of the patients, 85% of whom had a high VBQ score. Fracture occurred more than 60 days after the index procedure in 80% of the patients. Based on time-to-event analysis, secondary fracture occurred more often and earlier in patients with a VBQ score ≥ 3.0. CONCLUSIONS The VBQ score was not significantly affected by VCF. A high score (≥ 3.0) was common in patients who had undergone vertebroplasty and sustained a secondary fracture. Most fractures occurred ≥ 60 days from vertebroplasty, suggesting that initiation of anti-osteoporosis therapies after such a procedure may be useful. The VBQ score may be helpful in identifying high-risk patients who may need additional evaluation and anti-osteoporosis therapy.