Individuals with heterogenous trabecular bone texture by clinical magnetic resonance imaging have lower bone strength and stiffness by quantitative computed tomography-based finite element analysis.

This article investigates the relationship between heterogeneity of trabecular bone texture assessed by clinical magnetic resonance imaging (MRI) and biomechanical properties of vertebral bone estimated by quantitative computed tomography (QCT)-based finite element analysis (FEA). In a prospective study of 30 adults undergoing lumbar spine surgery, greater MRI-based texture heterogeneity—characterized by higher contrast and entropy and lower angular second moment (ASM) and inverse difference moment (IDM)—was associated with lower vertebral stiffness, failure load, and volumetric bone mineral density (vBMD) measured by QCT. These findings suggest that MRI texture analysis, which can be performed opportunistically on routine clinical scans without ionizing radiation, may serve as a noninvasive screening tool to identify skeletal fragility and osteoporosis risk. Further research is needed to validate clinical thresholds and expand applicability beyond the studied surgical population.