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Objective <p>This study aims to explore the application of vertebral bone quality scores based on magnetic resonance imaging and its combination with bone density in identifying fragility fractures in postmenopausal women with type 2 diabetes.</p> Methods <p>In this prospective single-center study, 300 postmenopausal women diagnosed with T2DM were recruited between January 2021 and June 2025. Each participant underwent both DXA scanning and lumbar spine (1–4) MRI. VBQ scores were derived from non-contrast T1-weighted sagittal images. Based on the presence or absence of fragility fractures, participants were stratified into a fracture group (<i>n</i> = 66) and a non-fracture group (<i>n</i> = 234). Factors independently associated with fragility fractures were first assessed using multivariable logistic regression, and discriminatory performance was subsequently evaluated using receiver operating characteristic (ROC) curve analysis.</p> Results <p>The mean age of the overall cohort was 63.56 years. The overall incidence of fragility fractures was 22.00%. Compared with the non-fracture group, individuals with fractures exhibited significantly higher VBQ scores (4.50 ± 0.50 vs. 3.70 ± 0.45, <i>P</i> &lt; 0.001), lower absolute BMD values, and lower L1-L4 T-scores across all measured skeletal sites. Multivariable analysis identified VBQ (OR = 2.58, <i>P</i> &lt; 0.001), age (OR = 1.08), HbA1c (OR = 1.20), and DXA-derived bone measurements as factors independently associated with fragility fractures. In ROC analysis, VBQ yielded an area under the curve (AUC) of 0.84 for fracture discrimination, compared with AUCs of 0.67 for femoral neck T-score, 0.71 for lumbar spine (1–4) T score, and 0.65 for total hip T-score. The combination of VBQ and femoral neck T-score produced the highest diagnostic accuracy, with an AUC of 0.89.</p> Conclusion <p>VBQ scoring based on lumbar MRI provides clinically valuable information for assessing vertebral bone status and discriminating fragility fractures in postmenopausal women with T2DM. While offering insights into bone microstructural alterations complementary to conventional BMD measurement, VBQ may serve as a useful adjunctive tool for fracture discrimination in this high-risk population.</p>

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Application of MRI-based vertebral bone quality scoring and its integration with BMD for identifying fragility fractures in postmenopausal women with type 2 diabetes mellitus

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Bo Yuan,
  • Xiaobo Zhang,
  • Hengfen Hu

摘要

Objective

This study aims to explore the application of vertebral bone quality scores based on magnetic resonance imaging and its combination with bone density in identifying fragility fractures in postmenopausal women with type 2 diabetes.

Methods

In this prospective single-center study, 300 postmenopausal women diagnosed with T2DM were recruited between January 2021 and June 2025. Each participant underwent both DXA scanning and lumbar spine (1–4) MRI. VBQ scores were derived from non-contrast T1-weighted sagittal images. Based on the presence or absence of fragility fractures, participants were stratified into a fracture group (n = 66) and a non-fracture group (n = 234). Factors independently associated with fragility fractures were first assessed using multivariable logistic regression, and discriminatory performance was subsequently evaluated using receiver operating characteristic (ROC) curve analysis.

Results

The mean age of the overall cohort was 63.56 years. The overall incidence of fragility fractures was 22.00%. Compared with the non-fracture group, individuals with fractures exhibited significantly higher VBQ scores (4.50 ± 0.50 vs. 3.70 ± 0.45, P < 0.001), lower absolute BMD values, and lower L1-L4 T-scores across all measured skeletal sites. Multivariable analysis identified VBQ (OR = 2.58, P < 0.001), age (OR = 1.08), HbA1c (OR = 1.20), and DXA-derived bone measurements as factors independently associated with fragility fractures. In ROC analysis, VBQ yielded an area under the curve (AUC) of 0.84 for fracture discrimination, compared with AUCs of 0.67 for femoral neck T-score, 0.71 for lumbar spine (1–4) T score, and 0.65 for total hip T-score. The combination of VBQ and femoral neck T-score produced the highest diagnostic accuracy, with an AUC of 0.89.

Conclusion

VBQ scoring based on lumbar MRI provides clinically valuable information for assessing vertebral bone status and discriminating fragility fractures in postmenopausal women with T2DM. While offering insights into bone microstructural alterations complementary to conventional BMD measurement, VBQ may serve as a useful adjunctive tool for fracture discrimination in this high-risk population.