Purpose <p>This study aimed to investigate the correlation between vertebral bone quality (VBQ) scores and bone mineral density (BMD) based on dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). The diagnostic efficacy of VBQ scores for predicting abnormal bone mass were compared.</p> Methods <p>Totally 222 volunteers participated in this prospective study. All subjects were divided into normal, osteopenia and osteoporosis (OP) according to DXA and QCT standards, respectively. T1-weighted non-contrast MRI was performed to calculate VBQ scores. The differences in VBQ scores among three groups were analyzed. The receiver-operating characteristic (ROC) curves were performed to determine diagnostic efficiency of VBQ scores in predicting low bone mass (LBM) and OP.</p> Results <p>Whether DXA or QCT was chosen as the gold standard, there were significant differences in VBQ scores among three groups (all <i>P </i>≤ 0.001), The predictive powers of VBQ scores for LBM and OP based on QCT were higher than that based on DXA. The diagnostic efficacy of single-level VBQ scores for abnormal bone mass was comparable to that of the overall VBQ score. Especially, the VBQ_L1 score demonstrated the best diagnostic performance. </p> Conclusion <p>VBQ score is a relatively effective screening tool for LBM and OP. The powers of VBQ scores in predicting LBM and OP based on QCT standard were higher than that based on DXA. VBQ_L1 score may be an ideal imaging marker for predicting LBM and OP.</p>