Can VBQ scores predict if a patient will have another vertebral fracture?

A VBQ (vertebral bone quality) score is a number taken from an MRI scan of the lower spine. It estimates how good the bone quality is. A higher VBQ score generally means poorer bone quality. The question is whether this score can predict who will break another vertebra. The short answer is yes: across several studies, people with higher VBQ scores were more likely to have a new vertebral fracture, and the score predicted this with fair to good accuracy ⁴⁶⁷⁸. It is not a perfect test on its own, so doctors usually combine it with other information.

What the research says

A large meta-analysis pooled 29 studies with 7,364 patients and looked at VBQ and Hounsfield unit (HU) values, which are CT-based measures of bone density. It found that VBQ was significantly higher in people who went on to have a subsequent fracture than in those who did not (mean difference 0.58), while HU values were significantly lower in the fracture group ⁴. The accuracy was moderate to good: the area under the curve was 0.85 for VBQ and 0.82 for HU, with VBQ showing a sensitivity of 0.85 and specificity of 0.66 ⁴. In plain terms, VBQ caught most future fractures but also flagged some people who did not go on to fracture.

What to ask your doctor

• Can you explain what my VBQ score means for my personal risk of another vertebral fracture?
• Should my VBQ score be combined with other tests, like a DXA scan or CT Hounsfield units, to get a better picture of my bone health?
• If my VBQ score is high, what options do I have to lower my risk of another fracture?
• How often should I have follow-up imaging or check-ups to watch for new fractures?
• Are there other risk factors, like my walking speed or balance, that we should consider together with my VBQ score?