Objective Hounsfield units (HU), vertebral bone quality (VBQ), and bone mineral density (BMD) can all serve as predictive indicators for thoracolumbar fragility fractures. This study aims to explore which indicator provides better risk prediction for thoracolumbar fragility fractures.
Methods Patients who have received medical attention from The First Affiliated Hospital of Anhui Medical University for thoracolumbar fragility fractures were selected. A total of 78 patients with thoracolumbar fragility fractures were included in the study. To establish a control group, 78 patients with degenerative spinal diseases were matched to the fracture group on the basis of gender, age, and body mass index. The lumbar vertebral HU, the VBQ, and the BMD were obtained for all the 156 patients through computed tomography, magnetic resonance imaging, and dual-energy x-ray absorptiometry (DEXA). The correlations among these parameters were analyzed. The area under curve (AUC) analysis was employed to assess the predictive efficacy and thresholds of lumbar vertebral HU, VBQ, and BMD in relation to the risk of thoracolumbar fragility fractures.
Results Among the cohort of 156 patients, lumbar vertebral HU exhibited a positive correlation with BMD (p < 0.01). Conversely, VBQ showed a negative correlation with HU, BMD (p < 0.05). HU and BMD displayed a favorable predictive efficacy for thoracolumbar fragility fractures (p < 0.01), with HU (AUC = 0.863) showcasing the highest predictive efficacy, followed by the DEXA-measured BMD (AUC = 0.813). VBQ (AUC = 0.602) ranked lowest among the 3 indicators. The thresholds for predicting thoracolumbar fragility fractures were as follows: HU (88),VBQ (3.37), and BMD (0.81).
Conclusion All 3 of these indicators, HU, VBQ, and BMD, can predict thoracolumbar fragility fractures. Notably, lumbar vertebral HU exhibits the highest predictive efficacy, followed by the BMD obtained through DEXA scanning, with VBQ demonstrating the lowest predictive efficacy.
Citations
Citations to this article as recorded by
Evaluation of bone mineral density in patients with cervical ossification of the posterior longitudinal ligament utilizing vertebral bone quality and Hounsfield units Kangcheng Zhao, Tong Su, JuHan Li, WeiBo Huang, HuaBin Yin European Spine Journal.2026; 35(4): 1785. CrossRef
Comparison between Hounsfield unit value and vertebral bone quality score for adjacent vertebral fracture risk assessment after balloon kyphoplasty: a propensity score matching study Koji Matsumoto, Masahiro Hoshino, Hirokatsu Sawada, Sosuke Saito, Tomohiro Furuya, Hirohiko Tsujisawa, Ryo Ozaki, Kazuyoshi Nakanishi Asian Spine Journal.2026; 20(1): 52. CrossRef
Disuse Bone Loss in Fusion Constructs After Multilevel Lumbar Fusion: A Computed Tomography Hounsfield Unit Analysis Hyun-Jun Jang, Dongkyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Dong-Kyu Chin Neurospine.2026; 23(1): 176. CrossRef
Abdominal aortic calcification and functional recovery in patients undergoing posterior lumbar interbody fusion: a retrospective cohort study Shangshu Wei, Sizheng Zhan, Yanjun Huang, Danning Lu, Chenxu Liu, Haoning Ma, Ping Yi, Xiangsheng Tang European Spine Journal.2026;[Epub] CrossRef
S1 vertebral Hounsfield Unit value independently predicts pedicle screw loosening after posterior lumbar interbody fusion in patients with lumbar degenerative diseases Han Ke, Minghui Liang, Yu Xi, Ruiyuan Chen, Congying Zou, Tianyi Wang, Aobo Wang, Ziqian Ma, Ning Fan, Shuo Yuan, Lei Zang BMC Surgery.2026;[Epub] CrossRef
The Role of Hounsfield Units in Predicting Cage Subsidence After Lateral Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis Chen Zhang, Zachary Chu, Jonathan Boey, Reuben Chee Cheong Soh World Neurosurgery.2026; 208: 124836. CrossRef
Diagnostic performance of lumbar computed tomography Hounsfield unit thresholds for osteoporosis and osteopenia: a systematic review and meta-analysis Omar Lubbad, Akram Hagos, Laila Lubbad, Yahya El-Tahlawy, Giuseppe Lambros Morassi, Nektarios K. Mazarakis Osteoporosis International.2026;[Epub] CrossRef
Morphological characteristics of lumbar vertebral bodies and regional distribution patterns of bone mineral density: a CT study Xiaoteng Li, Fengzi Lv, Xin Tang, Peng Jia, Yang Gao Frontiers in Physiology.2026;[Epub] CrossRef
Comparison of Hounsfield Unit, Vertebral Bone Quality, and Dual-Energy X-Ray Absorptiometry T-Score for Predicting Cage Subsidence After Posterior Lumbar Interbody Fusion Yunsheng Wang, Jiali Zhang, Tong Tong, Dechao Miao, Feng Wang, Linfeng Wang Global Spine Journal.2025; 15(4): 2226. CrossRef
Comprehensive Diagnostic Value of Vertebral Bone Quality Scores and Paravertebral Muscle Quality Parameters in Osteoporotic Vertebral Fractures Song Wang, Le Liu, Hao Liu, Xiang Zhang, Honglin Liao, Ping He, Hao Yang, Hongsheng Yang, Bo Qu World Neurosurgery.2025; 194: 123503. CrossRef
Does Baseline Hounsfield Unit Predict Patients’ Outcomes Following Surgical Management of Unstable Osteoporotic Thoracolumbar Fractures? Ahmed Qretam, Julien Ceuterick, Maher Ghandour, Ümit Mert, Christian Herren, Miguel Pishnamaz, Matthias Knobe, Frank Hildebrand, Rolf Sobottke, Mohamad Agha Mahmoud Medicina.2025; 61(2): 227. CrossRef
Prevalence and Predictors of Osteoporosis and Osteopenia in Lagos, Nigeria Taoreed Adegoke Azeez, Babajide Lawson, Aishat Usman Aminu, Deborah Oluwatoyin Ola, Hosanna Nnennaya Obasi SN Comprehensive Clinical Medicine.2025;[Epub] CrossRef
Analysis of the Predictive Efficiency of Lumbar Vertebral Body Quantification (VBQ) and CT Hounsfield Units (HUs) for Bone Density: Age and Gender Differences Xianghe Wang, Minghang Chen, Chenjie Shan, Xiang Fang, Chaohui Ding, Zongjie Yuan, Honglin Teng Global Spine Journal.2025; 15(8): 3869. CrossRef
Emerging MRI-based spine scoring techniques targeting bone quality to assess osteoporosis, vertebral fracture risk, other spinal degenerative diseases, and post-surgical outcomes Rahman Ud Din, Haisheng Yang La radiologia medica.2025; 130(9): 1442. CrossRef
Predicting osteoporosis-related complications in lumbar spine surgery using Hounsfield unit and vertebral bone quality scores: A 5-Year follow-up study with principal component analysis insights Yuki Kinoshita, Hiroshi Taniwaki, Takashi Namikawa, Akira Matsumura, Minori Kato, Yusuke Hori, Masatoshi Hoshino, Shinji Takahashi, Koji Tamai, Akinobu Suzuki, Hiromitsu Toyoda, Hiroaki Nakamura, Hidetomi Terai European Spine Journal.2025; 34(11): 5148. CrossRef
Regional variations and spatial heterogeneity of lumbar CT attenuation are associated with osteoporotic vertebral fracture Jinhui Cai, Ludan Chen, Long Liu, Jinsheng Yi, Jiaqi Wu, Tingqian Yang, Wensheng Huang, Qingyu Liu Frontiers in Endocrinology.2025;[Epub] CrossRef
Magnetic Resonance Imaging-Based Assessment of Bone Quality Using Vertebral Bone Quality (VBQ) Scores in Spine Surgery—A Critical Assessment and Narrative Review Adeesya Gausper, Wende N. Gibbs, Benjamin D. Elder, Justin K. Scheer, Tiffany G. Perry, Suhas K. Etigunta, Andy M. Liu, Alexander Tuchman, Corey T. Walker Journal of Clinical Medicine.2025; 14(18): 6477. CrossRef
Role of S1 vertebral Hounsfield units value and bone quality score in predicting new vertebral compression fracture after percutaneous kyphoplasty Minghui Liang, Ruiyuan Chen, Tianyi Wang, Ning Fan, Shuo Yuan, Peng Du, Aobo Wang, Yu Xi, Lei Zang European Spine Journal.2025;[Epub] CrossRef
Preoperative bone mineral density quantitatively assessed by Hounsfield units is associated with failed back surgery syndrome after lumbar fusion surgery: a retrospective study Longlong Qiu, Haocheng Xu, Liming Yu, Xiaojie Chen, Junwei Qu, Xinlei Xia, Chaojun Zheng, Qiwang Chen Asian Spine Journal.2025; 19(6): 939. CrossRef
Simplified S1 Vertebral Bone Quality Score in the Assessment of Patients with Vertebral Fragility Fractures Song Wang, Yongrong Hu, Hao Liu, Kunhai Yang, Xiang Zhang, Bo Qu, Hongsheng Yang World Neurosurgery.2024; 185: e1004. CrossRef
Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation Samer M Alboun, Eman Khreisat, Zaid E Alawneh, Khaled M Bani Hani, Rania F Khreisat, Mohammed A Al-Mughrabi, Bara’ah E Alshagoor, Rabaa I Alfarajat, Madher A Doumi, Mino Cycline Cureus.2024;[Epub] CrossRef
The association between body mass index and bone mineral density in older adults: a cross-sectional study of community population in Beijing Peng Cui, Wei Wang, Zheng Wang, Xinli Hu, Xu Liu, Chao Kong, Shibao Lu BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
Exploring the impact of body mass index on the accuracy of vertebral bone quality in determining bone mineral density in patients undergoing lumbar fusion surgery Xuan Zhao, Qijun Wang, Peng Wang, Chao Kong, Shibao Lu Journal of Orthopaedic Surgery and Research.2024;[Epub] CrossRef
Comparative effectiveness of four techniques for identifying vertebral fragility fractures among elderly patients Hui-Ya Ma, Ren-Jie Zhang, Lu-Ping Zhou, Yan-Xin Wang, Jia-Qi Wang, Cai-Liang Shen, Xiu-Jun Zhang European Radiology.2024; 35(6): 3673. CrossRef
First
Prev
