Vertebral-level discrimination of incidental vertebral fractures using volumetric BMD, texture features, and finite element–derived fracture load: an exploratory study

OBJECTIVE: To assess the discriminatory ability of vertebra-specific volumetric bone mineral density (vBMD), finite element analysis-derived fracture load (FEA-derived FL), and texture analysis (TA) features for incidental vertebral fractures, and to compare performance between thoracic and lumbar levels. MATERIALS AND METHODS: We retrospectively reviewed baseline and follow-up thoracolumbar CT scans from 420 patients and identified 11 patients with incidental vertebral fractures contributing to 20 fractured vertebrae (7 females; mean age 65.5years). For each fractured vertebra, three level-matched control vertebrae from patients without fractures were selected, yielding 58 controls across 29 control patients (total 78 vertebrae). Parameters evaluated include vBMD, FEA-derived FL, and TA features (24 total). Discriminatory ability was assessed using area under the curve (AUC) values. RESULTS: vBMD, FEA-derived FL, and 4 of 24 TA features showed group-wise differences between fractured and control vertebrae groups. AUCs were 0.76 [95% CI 0.55-0.90] (vBMD) and 0.73 [95% CI 0.52-0.90] (FEA-derived FL); selected texture features ranged 0.70-0.72. Region-stratified AUC point estimates were higher in the lumbar than in the thoracic vertebrae, but the 95% CIs were wide/overlapping; comparisons are descriptive. CONCLUSION: vBMD had the numerically largest AUC point estimate for discriminating fractured from control vertebrae; FEA-derived FL was similar, and selected texture features showed modest discrimination with comparable point estimates across lumbar and thoracic levels, generating the hypothesis of less region dependence. Regional comparisons are descriptive. Findings are exploratory and intended to prioritize candidate measures for validation and future multivariable modeling before any clinical application.