Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis

Abstract Purpose To investigate the diagnostic efficacy of vertebral fat fraction (FF) and R2* derived from the Fat Analysis and Calculation Technique (FACT) for Osteoporosis (OP) and explore their associations with clinical parameters. Methods A total of 123 patients with low back pain (59.1 ± 15.1...

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Main Authors: Fang Wu, Dongying Su, Hui Hu, Jinzhan Su, Shufeng Fan, Xia Song
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-08964-7
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author Fang Wu
Dongying Su
Hui Hu
Jinzhan Su
Shufeng Fan
Xia Song
author_facet Fang Wu
Dongying Su
Hui Hu
Jinzhan Su
Shufeng Fan
Xia Song
author_sort Fang Wu
collection DOAJ
description Abstract Purpose To investigate the diagnostic efficacy of vertebral fat fraction (FF) and R2* derived from the Fat Analysis and Calculation Technique (FACT) for Osteoporosis (OP) and explore their associations with clinical parameters. Methods A total of 123 patients with low back pain (59.1 ± 15.1 years, 41males) underwent lumbar FACT magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) within 48 h. FF, R2*, BMD, T-scores, and Z-scores were measured at L1–L4 vertebrae. Based on WHO criteria (T-score), subjects were categorized into normal (T ≥ − 1), osteopenia (− 2.5 < T < − 1), and OP (T ≤ − 2.5) groups. Statistical analyses included ANOVA, Pearson/Spearman correlations, and ROC curve analysis. Results The OP group exhibited significantly higher FF values compared to the normal group (overall: 59.8% vs. 47.7%, P < 0.001), with a more pronounced increase in females (between-group FF difference: F = 23.5 vs. males F = 4.6). R2* decreased progressively with bone loss (overall: 134.2 Hz vs. 162.0 Hz in normal group, P = 0.001). FF showed a strong positive correlation with age (overall: r = 0.66, P < 0.001) and negative correlations with BMD and T-scores (overall: r = − 0.42 and − 0.45, P < 0.001). R2* was negatively correlated with age (overall: r = − 0.48, P < 0.001), particularly in males (r = − 0.61 vs. females r = − 0.36). The multi-parameter model demonstrated superior diagnostic performance for osteopenia (AUC = 0.794, 95%CI: 0.699–0.866) and OP (AUC = 0.893, 95%CI: 0.814–0.947), outperforming single parameters. Conclusion FACT technology quantifies age and sex specific patterns of marrow FF and R2* during osteoporosis progression. The multi-parameter model significantly enhances diagnostic accuracy, providing a comprehensive imaging-metabolic biomarker for individualized OP assessment.
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spelling doaj-art-962d90212ac7456ab9c21e58dd0095212025-08-20T03:45:43ZengBMCBMC Musculoskeletal Disorders1471-24742025-07-012611910.1186/s12891-025-08964-7Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosisFang Wu0Dongying Su1Hui Hu2Jinzhan Su3Shufeng Fan4Xia Song5Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province)Abstract Purpose To investigate the diagnostic efficacy of vertebral fat fraction (FF) and R2* derived from the Fat Analysis and Calculation Technique (FACT) for Osteoporosis (OP) and explore their associations with clinical parameters. Methods A total of 123 patients with low back pain (59.1 ± 15.1 years, 41males) underwent lumbar FACT magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) within 48 h. FF, R2*, BMD, T-scores, and Z-scores were measured at L1–L4 vertebrae. Based on WHO criteria (T-score), subjects were categorized into normal (T ≥ − 1), osteopenia (− 2.5 < T < − 1), and OP (T ≤ − 2.5) groups. Statistical analyses included ANOVA, Pearson/Spearman correlations, and ROC curve analysis. Results The OP group exhibited significantly higher FF values compared to the normal group (overall: 59.8% vs. 47.7%, P < 0.001), with a more pronounced increase in females (between-group FF difference: F = 23.5 vs. males F = 4.6). R2* decreased progressively with bone loss (overall: 134.2 Hz vs. 162.0 Hz in normal group, P = 0.001). FF showed a strong positive correlation with age (overall: r = 0.66, P < 0.001) and negative correlations with BMD and T-scores (overall: r = − 0.42 and − 0.45, P < 0.001). R2* was negatively correlated with age (overall: r = − 0.48, P < 0.001), particularly in males (r = − 0.61 vs. females r = − 0.36). The multi-parameter model demonstrated superior diagnostic performance for osteopenia (AUC = 0.794, 95%CI: 0.699–0.866) and OP (AUC = 0.893, 95%CI: 0.814–0.947), outperforming single parameters. Conclusion FACT technology quantifies age and sex specific patterns of marrow FF and R2* during osteoporosis progression. The multi-parameter model significantly enhances diagnostic accuracy, providing a comprehensive imaging-metabolic biomarker for individualized OP assessment.https://doi.org/10.1186/s12891-025-08964-7Magnetic resonance imagingFat quantification technologyFat fractionR2*Osteoporosis
spellingShingle Fang Wu
Dongying Su
Hui Hu
Jinzhan Su
Shufeng Fan
Xia Song
Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
BMC Musculoskeletal Disorders
Magnetic resonance imaging
Fat quantification technology
Fat fraction
R2*
Osteoporosis
title Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
title_full Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
title_fullStr Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
title_full_unstemmed Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
title_short Role of vertebral fat fraction and R2* based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
title_sort role of vertebral fat fraction and r2 based on fat analysis and calculation technique in the quantitative assessment of osteoporosis
topic Magnetic resonance imaging
Fat quantification technology
Fat fraction
R2*
Osteoporosis
url https://doi.org/10.1186/s12891-025-08964-7
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