Prediction of refracture risk after osteoporotic vertebral compression fracture surgery using the vertebral bone quality index from multi-sequence MRI.

This study aimed to evaluate the value of the vertebral bone quality (VBQ) index on MRI in predicting refracture after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fractures (OVCF) and to compare its performance with bone mineral density (BMD). We retrospectively analyzed OVCF patients treated with PVA between January 2019 and September 2024. Patients were followed for 12 months and divided into refracture and non-refracture groups. Clinical, imaging, and surgical data were collected. Logistic regression was used to identify independent risk factors, and receiver operating characteristic (ROC) curves assessed predictive performance. Among 124 patients, 29 (23.4%) developed refracture. Refracture was associated with lower BMI, reduced lumbar spine BMD, and higher VBQ values. Multivariate analysis confirmed T1VBQ and T2VBQ as independent risk factors, while lumbar spine BMD was protective. ROC analysis showed that the combined T1VBQ and T2VBQ model achieved higher predictive accuracy than individual parameters. MRI-based VBQ measurement is simple, non-invasive, and reproducible. T1VBQ and T2VBQ are independent predictors of refracture after PVA, and their combined use improves predictive performance beyond either measure alone, complementing traditional BMD.