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Sex differences in the accuracy of vertebral bone quality score assessing bone density in patients undergoing lumbar spinal fusion – Lumbar Fusion

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The article explores the use of the MRI-based vertebral bone quality (VBQ) score as a predictor of low bone mineral density (BMD) in patients undergoing spinal fusion. The study aimed to investigate the effect of sex on the diagnostic efficacy of the VBQ score and determine if there is a sex-specific threshold. The researchers analyzed data from 271 patients who underwent lumbar fusion, stratifying them by sex and bone density. They found that the correlation between VBQ and BMD was stronger in female patients than in male patients. Additionally, the predictive performance of VBQ in detecting low BMD was more consistent with the gold-standard DEXA results in female patients. However, the optimal thresholds for detecting low BMD were similar in both sexes. Overall, the VBQ score showed better discrimination between female patients with low BMD and those with normal bone density compared to male patients

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: Compared with male patients, VBQ has better discrimination between female patients with low BMD and those with normal bone density. Although the correlation between VBQ and bone density is weaker in male than in female patients, the optimal thresholds are similar in both sexes.

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J Neurosurg Spine. 2023 Dec 29:1-7. doi: 10.3171/2023.10.SPINE23721. Online ahead of print.ABSTRACTOBJECTIVE: Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides,

J Neurosurg Spine. 2023 Dec 29:1-7. doi: 10.3171/2023.10.SPINE23721. Online ahead of print.

ABSTRACT

OBJECTIVE: Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides a tool for primary screening of bone density. The validity of this score as a predictor across sexes has not been investigated. This study aimed to explore the effect of sex on the diagnostic efficacy of the VBQ in predicting osteopenia/osteoporosis and whether a sex-specific threshold exists.

METHODS: In this retrospective cohort study, patients who underwent lumbar fusion at a tertiary care center were reviewed. VBQ was obtained by noncontrast T1-weighted MRI. Patients were stratified according to sex and bone density. Data were analyzed between the groups. Pearson correlation analysis and linear regression were used to analyze the correlation between the VBQ and DEXA T values. Receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC) calculation, was used to evaluate the predictive performance of VBQ for low BMD in both sexes.

RESULTS: A total of 271 patients (92 male, 179 female patients) were analyzed. The correlation coefficient between VBQ and the lowest T value was -0.40 for male and -0.554 for female patients. In comparing the bone density subgroups, among male patients a significant difference in the VBQ scores was observed only between the normal and osteoporosis subgroups (p = 0.012). VBQ demonstrated statistically significant differences among female patients across all three subgroups (p < 0.001). The ROC analysis revealed that the predictive performance of VBQ in detecting low BMD was more consistent with the gold-standard DEXA results in female than in male patients (AUC 0.647 vs AUC 0.823, p = 0.02). The optimal thresholds were similar in both sexes.

S: Compared with male patients, VBQ has better discrimination between female patients with low BMD and those with normal bone density. Although the correlation between VBQ and bone density is weaker in male than in female patients, the optimal thresholds are similar in both sexes.

PMID:38157527 | DOI:10.3171/2023.10.SPINE23721

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Sex differences in the accuracy of vertebral bone quality score assessing bone density in patients undergoing lumbar spinal fusion

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J Neurosurg Spine. 2023 Dec 29:1-7. doi: 10.3171/2023.10.SPINE23721. Online ahead of print.ABSTRACTOBJECTIVE: Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides
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