Cervical and lumbar MRI-based vertebral bone quality scores: a novel diagnostic tool for the prediction osteoporosis

Background Osteoporosis is a significant global health issue, particularly in aging populations. Dual-energy X-ray absorptiometry (DXA) is the gold standard for osteoporosis diagnosis; however, its limitations have driven research into alternative methods. Purpose To explore the diagnostic potential of cervical MRI-derived vertebral bone quality (VBQ) scores in predicting osteoporosis, in comparison to lumbar vertebra measurements. Material and Methods This retrospective study included patients who had DXA scans between 2020 and 2023 and underwent cervical MRI within 6 months. A total of 213 patients were classified into normal (n = 72), osteopenia (n = 82), and osteoporosis (n = 59) groups based on their DXA T-scores. T1-weighted MRI images were used to measure vertebral body signal intensity (SI) and cerebrospinal fluid (CSF) SI, which were then used to calculate VBQ scores. Both cervical and lumbar VBQ scores were compared to DXA results to evaluate diagnostic efficacy. Results Cervical VBQ scores, particularly the C4:posterior fossa CSF SI ratio, demonstrated significant correlations with DXA T-scores ( P = 1.7 × 10 −5 ). The study found that the C4:posterior fossa CSF SI ratio had a high diagnostic accuracy (AUC = 0.81) for distinguishing between normal bone density and osteopenia/osteoporosis. Furthermore, cervical VBQ scores showed stronger correlations with bone density than lumbar scores, suggesting that the cervical spine may serve as a more effective diagnostic region. Conclusion Cervical MRI-derived VBQ scores, especially the C4:posterior fossa CSF SI ratio, offer a promising non-invasive tool for osteoporosis diagnosis. This method may provide a complementary or alternative diagnostic approach to DXA, particularly in cases where lumbar imaging is insufficient.