Can VBQ scores and Hounsfield Units predict fractures after vertebral augmentation?

After a vertebral augmentation procedure (like kyphoplasty or vertebroplasty), some patients go on to have new fractures in nearby vertebrae. Doctors want to know who is at highest risk so they can plan follow-up care. Two imaging measurements — the MRI-based vertebral bone quality (VBQ) score and the CT-derived Hounsfield Unit (HU) value — can help predict these subsequent fractures. A large meta-analysis found that both measures are useful, with VBQ scores having slightly better sensitivity (85% vs 79%) for identifying patients who will fracture again ²⁹.

What the research says

A 2026 meta-analysis pooled 29 studies with over 7,300 patients who had vertebral augmentation and looked at how well VBQ and HU predicted subsequent fractures ²⁹. Patients who later fractured had significantly higher VBQ scores (mean difference 0.58) and significantly lower HU values (mean difference -24.69) compared to those who did not fracture ²⁹. The overall diagnostic accuracy was good: the area under the curve (a measure of test performance) was 0.85 for VBQ and 0.82 for HU ²⁹. Sensitivity (the ability to correctly identify those who will fracture) was 85% for VBQ and 79% for HU, while specificity (the ability to correctly identify those who will not fracture) was 66% for VBQ and 70% for HU ²⁹. This means VBQ is slightly better at catching high-risk patients, but both tests have similar ability to rule out risk.

A separate 5-year study of 189 patients who had lumbar spine surgery found that both HU and VBQ scores could predict osteoporosis-related complications, including new vertebral fractures and mechanical problems like cage subsidence ¹⁰. That study also suggested that combining the two measures might improve prediction, though the exact cutoff values need more research ¹⁰.

Another study focused specifically on adjacent vertebral fractures after kyphoplasty and found that lower HU values in the vertebral body and endplate, as well as higher endplate bone quality (EBQ) scores (a measure related to VBQ), were independent predictors of new fractures ¹¹. This reinforces that both CT and MRI measures of bone quality are valuable for risk assessment after augmentation ¹¹.

What to ask your doctor

• Should I have a VBQ score or HU measurement done before or after my vertebral augmentation to assess my fracture risk?
• What do my VBQ and HU values mean for my personal risk of a subsequent fracture?
• If my VBQ score is high or HU is low, what additional steps can we take to lower my fracture risk?
• How often should I be monitored for new fractures after augmentation based on my bone quality scores?
• Are there other factors, like my age or bone density, that should be considered along with VBQ and HU?