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World Journal of Methodology

Quantitative MRI and Vertebral Bone Quality Scoring for Fragility Fracture Risk Prediction Beyond Density

This review indicates that bone mineral density from dual-energy X-ray absorptiometry (DEXA) explains only part of fracture risk, while quantitative MRI techniques (T1ρ, T2 mapping, proton density fat fraction, diffusion-weighted imaging) and Vertebral Bone Quality (VBQ) scoring capture bone quality through collagen integrity, proteoglycan content, water distribution, and marrow adiposity; VBQ predicts vertebral fragility fractures independently of BMD with sensitivity exceeding 90% and discriminatory ability comparable to the fracture risk assessment tool and trabecular bone score, and integration with artificial intelligence can support opportunistic, radiation-free screening.