MRI-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 VBQ scores and bone turnover markers in lumbar spine disorders. Summary of Background Data. Vertebral Bone Quality (VBQ) score is increasingly used in the assessment of bone mineral density, and bone quality profiles are closely related to bone metabolism. However, the level of bone turnover is often overlooked in clinical practice. 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 (MRI), with patients classified into High (>3.3), Middle (2.7-3.3), and Low (<2.7) VBQ groups. The data of Computed Tomography (CT) images and Dual-Energy X-ray Absorptiometry (DEXA) were collected to obtain the Hounsfield unit (HU) and T value. Correlation analysis, linear regression, and one-way ANOVA were used to analyze the relationship between bone turnover markers including Parathyroid hormone (ng/L), 25-hydroxyvitamin D3 (nmol/L), Osteocalcin (ng/mL), β-CTX (ng/mL), and P1NP (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(OH)D3, OC) decreasing and osteoclast-related markers (β-CTX) increasing with higher VBQ scores. Multivariate analysis confirmed age, gender, BMI, and specific BTMs(Except for PINP) as independent predictors of VBQ scores ( P =0.0075–0.0256). VBQ demonstrated superior correlations with BTMs (r=0.52–0.63) compared to 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 =0.0009–0.0036), 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 bone turnover markers in lumbar spine patients. Preoperative VBQ assessment via MRI can initially evaluate bone metabolism without radiation exposure, guiding osteoporosis treatment post-surgery to optimize bone health. Level of evidence. Level III.