Purpose <p>Vertebral fat-water changes are associated with osteoporosis or aging, and usually the changes are assessed with advanced magnetic resonance imaging (MRI) techniques. In this study, routine T1- and T2-weighted sequences are employed to introduce novel MRI scores for indicating fat-water-like changes.</p> Methods <p>A retrospective study of 165 females (42 ± 13 years), and a pilot study of twenty volunteers (60.85 ± 5.05) examined with MRI, were conducted. Mean signal intensities (SIs) were calculated for 926 vertebrae (L1 − L5). F-score_sc.fat (for fat) and W-score_cs.fluid (for water) were defined as the median SI from L1 − L5 over subcutaneous fat (T1WI-control) and cerebrospinal fluid (T2WI-control), respectively. Reliability analysis was conducted to evaluate the consistency of the scores, and Pearson correlation was used to assess the relationships between variables and age. Unpaired t-tests were employed to identify differences between the abnormal and control groups, with significance set at <i>p</i> &lt; 0.05. The distribution of scores was examined using box-and-whisker plots, alongside descriptive statistics for both the scores and associated diseases.</p> Results <p>Moderate-to-strong positive correlations were found between F-score_sc.fat (<i>r</i> = 0.67, <i>p</i> &lt; 0.05) and W-score_cs.fluid (<i>r</i> = 0.49, <i>p &lt; 0.05</i>) vs. patient age, compared to signal-to-noise ratio (SNR) vs. age (T1WI, <i>r</i> = 0.18; T2WI, <i>r</i> = 0.04). Significantly, higher scores were reported in patients with spine disorders. The F-score_sc.fat (5.77 and 4.36) and W-score_cs.fluid (6.67 and 5.13) were found to differentiate between volunteers with and without osteoporosis (defined by the DXA T-score).</p> Conclusion <p>A novel MRI scoring method was introduced indicating fat-water-like changes, utilizing routine sequences. The scores correlated with aging and can distinguish between healthy and diseased spines.</p>