MAGNETIC RESONANCE IMAGING–BASED BIOMARKERS FOR QUANTITATIVE ASSESSMENT OF VERTEBRAL BONE QUALITY IN OSTEOPOROSIS: A SYSTEMATIC REVIEW

Abstract

Purpose: To systematically review and synthesise MRI-based quantitative studies evaluating vertebral bone marrow parameters and their correlation with bone mineral density (BMD) in osteoporosis, and to assess the diagnostic and clinical utility of these MRI-derived biomarkers. Materials and Methods: A structured literature review was performed, including 22 original MRI-based studies and additional relevant technical and review articles. Eligible studies assessed vertebral bone marrow using quantitative or semi-quantitative MRI techniques and correlated imaging findings with DXA- or QCT-derived BMD. MRI methods included proton MR spectroscopy, chemical shift–encoded techniques (Dixon, mDIXON-Quant, IDEAL-IQ), diffusion weighted and intravoxel incoherent motion imaging, susceptibility-based parameters (R2*, T2*), and signal-intensity based metrics such as the vertebral bone quality (VBQ) score. Study design, imaging protocols, reference standards, and correlation outcomes were qualitatively analysed following PRISMA recommendations. Results: Across studies, vertebral marrow fat fraction consistently demonstrated a moderate-to-strong inverse correlation with BMD, irrespective of sex, age group, or reference standard. Diffusion, perfusion, and susceptibility-based parameters showed more variable associations but provided complementary information on bone microstructure. VBQ score showed moderate correlation with DXA and independent predictive value for fragility fractures. Methodological heterogeneity in MRI protocols and outcome reporting precluded quantitative meta-analysis. Conclusion: MRI-derived vertebral bone marrow biomarkers, particularly fat fraction and VBQ score, provide radiation free assessment of bone quality beyond BMD. Heterogeneous methods precluded meta-analysis, underscoring the need for standardised, prospective multicentre studies.