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Objective <p>This study aimed to evaluate the relationships among the Cervical Vertebral Bone Quality score (C-VBQ), mean Hounsfield units on cervical CT (C-HU), the lowest T-score from dual-energy X-ray absorptiometry (DXA), and bone turnover markers (BTMs). It also compared the performance of C-VBQ and C-HU in screening for DXA-defined low bone mass.</p> Methods <p>This retrospective study enrolled 91 patients undergoing surgery for degenerative cervical spondylosis who had preoperative cervical MRI, CT, DXA, and BTMs. Based on the lowest DXA T-score, patients were categorized as having normal bone mass (T ≥ -1.0), osteopenia (-2.5 &lt; T &lt; -1.0), or osteoporosis (T ≤ -2.5). Differences in C-VBQ and BTMs across groups were analyzed. Spearman correlation and multiple linear regression assessed associations between C-VBQ, imaging parameters, and BTMs. Additional partial correlation analyses were performed after controlling for age, sex, and BMI, and Benjamini–Hochberg false discovery rate correction was applied to the correlation heatmaps. Receiver operating characteristic (ROC) curves evaluated the ability of C-VBQ and C-HU to identify low bone mass (T &lt; -1.0). </p> Results <p>C-VBQ showed significant differences across DXA groups (<i>P</i> &lt; 0.001), while C-HU and the lowest T-score decreased progressively with worsening bone status (<i>P</i> &lt; 0.001). C-VBQ correlated negatively with C-HU (ρ = -0.523, <i>P</i> &lt; 0.001) and the lowest T-score (ρ = -0.512, <i>P</i> &lt; 0.001), and C-HU correlated positively with the lowest T-score (ρ = 0.613,<i> P</i> &lt; 0.001); these core imaging-based associations remained significant after FDR correction. After adjustment for age, sex, and BMI, C-VBQ remained associated with C-HU (partial r = -0.421, <i>P</i> &lt; 0.001) and the lowest T-score (partial r = -0.419, <i>P </i>&lt; 0.001). A weak association was observed between C-VBQ and β-CTX after adjustment (partial r = 0.221, <i>P</i> = 0.039), but the corresponding unadjusted heatmap association did not survive FDR correction (FDR q = 0.090). Multiple linear regression identified age (<i>P</i> = 0.016) and β-CTX (<i>P</i> = 0.037) as independent correlates of C-VBQ. For screening low bone mass, the area under the curve (AUC) was 0.702 for C-VBQ (optimal cutoff: 3.48; sensitivity 0.492, specificity 0.906) and 0.773 for C-HU (optimal cutoff: 324.57 HU; sensitivity 0.729, specificity 0.781). </p> Conclusion <p>In patients undergoing cervical spine surgery, C-VBQ demonstrates consistent associations with C-HU and DXA T-scores, supporting its potential for opportunistic preoperative bone quality assessment. The association between C-VBQ and β-CTX was weak and exploratory. Integrating radiological indicators such as C-VBQ and C-HU with DXA and BTMs may enable a more comprehensive, but still cautiously interpreted, perioperative bone health evaluation.</p>

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C-VBQ and CT hounsfield units for DXA-defined low bone mass screening and their associations with bone turnover markers

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Xiaoteng Feng,
  • Xiujia Xia,
  • Zelin Shen,
  • Yan Gong,
  • Zhenghao Huang,
  • Bin Xie,
  • Chenxing Huang,
  • Zhuangzhuang Tan,
  • Jiajun Cheng,
  • Shengyao Liu,
  • Hui Ren,
  • Xiaobing Jiang,
  • Zhaojun Cheng,
  • Binwei Chen

摘要

Objective

This study aimed to evaluate the relationships among the Cervical Vertebral Bone Quality score (C-VBQ), mean Hounsfield units on cervical CT (C-HU), the lowest T-score from dual-energy X-ray absorptiometry (DXA), and bone turnover markers (BTMs). It also compared the performance of C-VBQ and C-HU in screening for DXA-defined low bone mass.

Methods

This retrospective study enrolled 91 patients undergoing surgery for degenerative cervical spondylosis who had preoperative cervical MRI, CT, DXA, and BTMs. Based on the lowest DXA T-score, patients were categorized as having normal bone mass (T ≥ -1.0), osteopenia (-2.5 < T < -1.0), or osteoporosis (T ≤ -2.5). Differences in C-VBQ and BTMs across groups were analyzed. Spearman correlation and multiple linear regression assessed associations between C-VBQ, imaging parameters, and BTMs. Additional partial correlation analyses were performed after controlling for age, sex, and BMI, and Benjamini–Hochberg false discovery rate correction was applied to the correlation heatmaps. Receiver operating characteristic (ROC) curves evaluated the ability of C-VBQ and C-HU to identify low bone mass (T < -1.0).

Results

C-VBQ showed significant differences across DXA groups (P < 0.001), while C-HU and the lowest T-score decreased progressively with worsening bone status (P < 0.001). C-VBQ correlated negatively with C-HU (ρ = -0.523, P < 0.001) and the lowest T-score (ρ = -0.512, P < 0.001), and C-HU correlated positively with the lowest T-score (ρ = 0.613, P < 0.001); these core imaging-based associations remained significant after FDR correction. After adjustment for age, sex, and BMI, C-VBQ remained associated with C-HU (partial r = -0.421, P < 0.001) and the lowest T-score (partial r = -0.419, P < 0.001). A weak association was observed between C-VBQ and β-CTX after adjustment (partial r = 0.221, P = 0.039), but the corresponding unadjusted heatmap association did not survive FDR correction (FDR q = 0.090). Multiple linear regression identified age (P = 0.016) and β-CTX (P = 0.037) as independent correlates of C-VBQ. For screening low bone mass, the area under the curve (AUC) was 0.702 for C-VBQ (optimal cutoff: 3.48; sensitivity 0.492, specificity 0.906) and 0.773 for C-HU (optimal cutoff: 324.57 HU; sensitivity 0.729, specificity 0.781).

Conclusion

In patients undergoing cervical spine surgery, C-VBQ demonstrates consistent associations with C-HU and DXA T-scores, supporting its potential for opportunistic preoperative bone quality assessment. The association between C-VBQ and β-CTX was weak and exploratory. Integrating radiological indicators such as C-VBQ and C-HU with DXA and BTMs may enable a more comprehensive, but still cautiously interpreted, perioperative bone health evaluation.