Osteoporosis is characterized by increased skeletal fragility with vertebral fractures (VFs). Areal bone mineral density (BMD) from dual-energy X-ray absorptiometry (DXA) is the reference standard but has well-known limitations. Texture analysis (TA) can provide parameters of tissue microstructure using spine chemical shift encoding-based water-fat MRI (CSE-MRI) and computed tomography (CT), thus potentially improving fracture risk estimation. This study found that a model including volumetric BMD (vBMD) and several texture features (TFs) from CSE-MRI and CT predicts 81% of the variance regarding osteoporotic VF status, compared to 47% when based on vBMD and the proton density fat fraction (PDFF) only.
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