Many individuals at high-risk for fracture are never evaluated for osteoporosis and subsequently do not receive necessary treatment. Utilization of MRI is burgeoning, providing an ideal opportunity to use MRI to identify individuals with skeletal deficits. We previously reported that MRI-based bone texture was more heterogeneous in postmenopausal women with a history of fracture compared to controls. The present study aimed to identify the microstructural characteristics that underlie trabecular texture features.
In a prospective cohort, we measured spine vBMD by QCT, peripheral vBMD and microarchitecture by high-resolution peripheral QCT (HRpQCT), and aBMD by DXA. Vertebral trabecular bone texture was analyzed using T1-weighted MRIs. A gray level co-occurrence matrix was used to characterize the distribution and spatial organization of voxelar intensities and derive the following texture features: contrast (variability), entropy (disorder), angular second moment (ASM; uniformity), and inverse difference moment (IDM; local homogeneity).
Among 46 patients (mean age 64, 54% women), lower peripheral vBMD and worse trabecular microarchitecture by HRpQCT were associated with greater texture heterogeneity by MRI-higher contrast and entropy (r∼-0.3-0.4, p < 0.05), lower ASM and IDM (r∼+0.3-0.4, p < 0.05). Lower spine vBMD by QCT was associated with higher contrast and entropy (r∼-0.5, p < 0.001), lower ASM and IDM (r ∼+0.5, p < 0.001). Relationships with aBMD were less pronounced.
MRI-based measurements of trabecular bone texture relate to vBMD and microarchitecture, suggesting that this method reflects underlying microstructural properties of trabecular bone. Further investigation is required to validate this methodology, which could greatly improve identification of patients with skeletal fragility.

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