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The following is a summary of “Trabecular texture and paraspinal muscle characteristics for prediction of first vertebral fracture: a QCT analysis from the AGES cohort,” published in the March 2025 issue of Frontiers in Endocrinology by Hummel et al. 

Vertebral fractures (VFs) increased the risk of future fractures, while areal and volumetric bone mineral density (BMD) served as strong predictors.  

Researchers conducted a retrospective study using data from the Age, Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) cohort to determine whether trabecular texture and paraspinal muscle assessments improved the prediction of the first incident VF.  

They analyzed computed tomography (CT) scans of the lumbar vertebrae L1 and L2 from 843 older adults (OAs), including 167 with incident VFs within a 5-year period and 676 without fractures. Image analysis assessed BMD, cortical thickness, trabecular architecture, and autochthonous muscle parameters, 50 variables, including BMD, trabecular texture, and muscle-related factors, were used as predictors, incorporating age, BMI, and quantitative computed tomography (QCT) parameters. Stepwise logistic regression reduced the number of variables to develop multivariable fracture prediction models. Model accuracy was evaluated using the likelihood ratio test (LRT) and area under the curve (AUC) criteria. Bootstrap analyses assessed the stability of model selection.  

The results showed that 96 women and 78 men with prior VFs were excluded. Among 50 initial predictors, 17 were significant for women and 11 for men. Bone and texture models demonstrated superior fracture prediction in women (P <0.001) and men (P <0.01) compared to age and BMI. The muscle model improved fracture prediction in men only (P <0.03). Compared to the BMD model alone, the LRT indicated significantly enhanced VF prediction with BMD combined with texture (women and men) (P <0.05) or with muscle models (men only) (P =0.03). However, no significant increases were observed in AUC values (AUC women: Age&BMI: 0.57, BMD: 0.69, combined model: 0.69; AUC men: Age&BMI: 0.63, BMD: 0.71, combined models: 0.73-0.77).  

Investigators concluded that while trabecular texture and muscle parameters improved VF prediction beyond age and BMI, the enhancements were minor compared to BMD, which remained the strongest predictor for both sexes. 

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1566424/full