Diagnostic performance of paraspinal muscle fat-free cross-sectional area versus vertebral bone quality score for osteoporosis identification on lumbar MRI
BMC Musculoskeletal Disorders · 26 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Patients being worked up for lumbar surgery often get an MRI but no DXA, so an MRI-based flag for osteoporosis could prompt bone health testing before instrumentation.
The evidence
In 150 spine surgery patients aged 40 and over who had both lumbar MRI and DXA at one Chinese centre (half of whom were osteoporotic by the lowest T-score), the authors compared the MRI vertebral bone quality (VBQ) score with paraspinal muscle measurements for detecting osteoporosis. The fat-free cross-sectional area of the psoas major (AUC 0.761) and erector spinae plus multifidus (AUC 0.759) discriminated osteoporosis better than VBQ (AUC 0.611, DeLong P = 0.023 and 0.019). Adding VBQ to psoas fat-free area raised the AUC to 0.785, but this was not significantly better than psoas fat-free area alone.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Diagnostic accuracyDesign starting point: 40
Raised the score
- Blinded outcome assessment+3.4
- Aligned time zero+2.5
Lowered the score
- A single centre's own patients−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedMet
- Comparable start of follow-upMet
- Adequate statistical powerCalculation absent
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 40
- Aligned time zero
- +2.5
- Compared against an accepted alternative
- +1.7
- Blinded outcome assessment
- +3.4
- A single centre's own patients
- −3.4
- Consecutive enrolment
- +2.5
- Final rigour score rounded
- 47 / 100
Study design sets the starting point and a ceiling of 80. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If a preoperative lumbar MRI shows a small psoas fat-free cross-sectional area, should that trigger a DXA scan and bone health workup before planning pedicle screw fixation?
2.How would you counsel a woman with degenerative lumbar disease and low paraspinal muscle mass about fracture risk and the value of exercise or anti-osteoporotic treatment before spinal fusion?
Original publication title
Diagnostic performance of paraspinal muscle fat-free cross-sectional area versus vertebral bone quality score for osteoporosis identification on lumbar MRI