Vertebral bone quality score predicts fragility fractures independently of bone mineral density |
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| Authors: | Jeff Ehresman Andrew Schilling Xinghai Yang Zach Pennington Ali Karim Ahmed Ethan Cottrill Daniel Lubelski Majid Khan Kendall F. Moseley Daniel M. Sciubba |
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| Affiliation: | 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA;2. Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China;3. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;4. Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;1. The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX, USA;3. State University of New York Upstate Medical University, 750 East Adams St, Syracuse, NY 13210-2375, USA;4. Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA;5. Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA;6. Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA;1. Laboratory of Cell Biology, Department of Orthopedic Surgery University Hospital of Tübingen, Waldhörnlestraße 22, 72072 Tübingen, Germany;2. Department of Orthopedic Surgery University Hospital of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany;3. Medical Faculty of the University of Tübingen, Geissweg 5/1, 72076 Tübingen, Germany;4. Bavarian Health and Food Authority, Veterinärstraße 2, 85764 Oberschleißheim, Germany;5. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany;1. Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India;2. Ganga Research Centre, No 91, Mettupalayam Rd, Coimbatore 641030, India;3. Department of Plant Biotechnology, Tamil Nadu agricultural university, Coimbatore 641003, India;4. Aravind Medical Research Foundation, Madurai 625020, India;1. Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan;2. Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;3. Department of Medical Education, Taipei Veterans General Hospital, Taipei 11217, Taiwan;4. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;5. Research Center of Biostatistics, Taipei Medical University, Taipei 11031, Taiwan;6. Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;7. Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;8. Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan 70101, Taiwan;9. Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan |
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| Abstract: | BackgroundCurrent evidence suggests that dual-energy x-ray absorptiometry (DXA) scans, the conventional method defining osteoporosis, is underutilized and, when used, may underestimate patient risk for skeletal fragility. It has recently been suggested that other imaging modalities may better estimate bone quality, such as the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score which also may assess vertebral compression fracture risk in patients with spine metastases.PurposeTo evaluate whether VBQ score is predictive of fragility fractures in a population with pre-existing low bone density and at high-risk for fracture.Study Design/SettingRetrospective single-center cohort.Patient SamplePatients followed at a metabolic bone clinic for osteopenia and/or osteoporosis.Outcome MeasuresRadiographically-documented new-onset fragility fracture.MethodsPatients with a DXA and MRI scans at the time of consultation and ≥2-year follow-up were included. Details were gathered about patient demographics, health history, current medication use, and serological studies of kidney function and bone turnover. For each patient, VBQ score was calculated using T1-weighted lumbar MRI images. Univariable and multivariable analyses were used to identify the independent predictors of a new fragility fracture. To support the construct validity of VBQ, patient VBQ scores were compared to those in a cohort of 45 healthy adults.ResultsSeventy-two (39.1%) study participants suffered fragility fractures, the occurrence of which was associated with higher VBQ score (3.50 vs. 3.01; p<.001), chronic glucocorticoid use (30.6% vs. 15.2%; p=.014), and a history of prior fragility fracture (36.1% vs. 21.4%; p=.030). Mean VBQ score across all patients in the study cohort was significantly higher than the mean VBQ score in the healthy controls (p<.001). In multivariable analysis, new-onset fracture was independently associated with history of prior fracture (OR=6.94; 95% confidence interval [2.48–19.40]; p<.001), higher VBQ score (OR=2.40 per point; [1.30–4.44]; p=.003), higher body mass index (OR=1.09 per kg/m²; [1.01–1.17]; p=.03), and chronic glucocorticoid use (OR=2.89; [1.03–8.17]; p=0.043). Notably, DXA bone mineral density (BMD) was not found to be significantly predictive of new-onset fractures in the multivariable analysis (p=.081).ConclusionsHere we demonstrate the novel, MRI-derived VBQ score is both an independent predictor of fragility fracture in at-risk patients and a superior predictor of fracture risk than DXA-measured BMD. Given the frequency with which MRIs are obtained by patients undergoing spine surgery consultation, we believe the VBQ score could be a valuable tool for estimating bone quality in order to optimize the management of these patients. |
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