Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
J Orthop Surg Res. 2024 Nov 17;19(1):763. doi: 10.1186/s13018-024-05195-9.
To investigate whether body mass index (BMI) affects the accuracy of vertebral bone quality (VBQ) in determining bone mineral density (BMD) in patients undergoing lumbar fusion surgery.
In this retrospective study, patients with preoperative noncontrast T1-weighted MRI were included. Restricted Cubic Spline (RCS) was employed to explore the nonlinear relationship between BMI and VBQ. Then patients were stratified according to the threshold of BMI. Pearson correlation analysis and linear regression were used to analyze the correlation between VBQ and the BMD in different groups. Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was used to assess diagnostic efficacy according to BMI.
A total of 328 patients (201 female and 127 male patients) with a mean age of 68.3 ± 3.3 years were included in the study. Significant nonlinear relationship was observed given the results of RCS. In patients with BMI < 23.8 kg/m, the correlation coefficient between VBQ and the lowest BMD was - 0.32 and significant distribution difference of VBQ score was observed between osteoporosis and normal as well as osteopenia subgroups. However, in patients with BMI ≥ 23.8 kg/m, the correlation coefficient between VBQ and the lowest BMD was - 0.39 and significant distribution difference of VBQ score was observed in all three subgroups. In addition, the ROC analysis revealed that the predictive performance in determining low BMD was superior in patients with BMI ≥ 23.8 kg/m (AUC 0.80 vs. AUC 0.66, p = 0.034).
In this study, significant nonlinear relationship between BMI and VBQ was observed. Compared with patients with BMI < 23.8 kg/m, VBQ has better discrimination between higher BMI (≥ 23.8 kg/m) patients with low BMD and those with normal bone density.
研究体质量指数（BMI）是否会影响在接受腰椎融合手术的患者中，椎骨骨质量（VBQ）对骨密度（BMD）的评估准确性。
本回顾性研究纳入了术前接受过非对比 T1 加权 MRI 的患者。采用受限立方样条（RCS）探索 BMI 与 VBQ 之间的非线性关系。然后根据 BMI 的阈值对患者进行分层。采用 Pearson 相关分析和线性回归分析不同组中 VBQ 与 BMD 之间的相关性。根据 BMI 计算受试者工作特征（ROC）分析的曲线下面积（AUC），以评估诊断效能。
本研究共纳入 328 例患者（201 名女性和 127 名男性患者），平均年龄为 68.3±3.3 岁。RCS 的结果显示存在显著的非线性关系。在 BMI<23.8kg/m2的患者中，VBQ 与最低 BMD 的相关系数为-0.32，且在骨质疏松症和正常及骨量减少亚组中，VBQ 评分的分布差异有统计学意义。然而，在 BMI≥23.8kg/m2的患者中，VBQ 与最低 BMD 的相关系数为-0.39，且在所有三个亚组中，VBQ 评分的分布差异均有统计学意义。此外，ROC 分析表明，在 BMI≥23.8kg/m2的患者中，预测低 BMD 的性能更好（AUC 为 0.80 比 AUC 为 0.66，p=0.034）。
本研究中观察到 BMI 与 VBQ 之间存在显著的非线性关系。与 BMI<23.8kg/m2的患者相比，在 BMI 较高（≥23.8kg/m2）的患者中，VBQ 对低 BMD 与正常骨密度之间的区分具有更好的鉴别能力。
