Teriparatide enhances vertebral bone quality: Quantitative analysis using the VBQ score in lumbar fusion patients

Background Vertebral bone quality is a critical factor influencing spinal stability and surgical planning. The vertebral bone quality (VBQ) score, derived from routine MRI, has emerged as a noninvasive imaging biomarker of bone quality; however, its clinical implications in the perioperative spinal fusion setting remain incompletely understood. Methods This retrospective study included patients who underwent single-level lumbar fusion at L4–5. VBQ was measured at T12–L2 to avoid instrumentation-related artifacts. Associations between VBQ and radiographic parameters were evaluated using correlation and multivariable regression analyses. Inter- and intra-rater reliability were assessed using kappa statistics. Results VBQ scores significantly decreased in the PTH group (ΔVBQ −0.31 ± 0.56), indicating improved bone quality, whereas no improvement was observed in controls (ΔVBQ 0.08 ± 0.61; p = 0.03). HU changes did not differ between groups. ΔVBQ correlated with postoperative BMD (r = −0.28, p = 0.04) and PTH duration (r = −0.39, p = 0.01). Regression analysis identified PTH use (β = −0.39, 95%CI: −0.72 to −0.06, p = 0.02) and treatment duration (β = −0.27, 95%CI: −0.52 to −0.02, p = 0.03) as independent predictors of VBQ improvement with R 2 of 0.32. Conclusion Perioperative teriparatide significantly enhances vertebral bone quality, demonstrated by reduced VBQ scores over 12 months. VBQ appears more sensitive than HU or BMD to anabolic therapy–induced qualitative changes and may serve as a practical imaging biomarker for optimizing perioperative bone management in osteoporotic spinal fusion patients.