{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T03:44:39Z","timestamp":1782704679790,"version":"3.54.5"},"reference-count":84,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Technology Research and Development Program Project of the Liaoning Provincial Science and Technology Joint Program","award":["2024JH2\/102600170"],"award-info":[{"award-number":["2024JH2\/102600170"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: With the global population aging, osteoporosis and associated vertebral compression fractures are increasingly prevalent. While bone mineral density (BMD) remains the standard clinical parameter for diagnosing osteoporosis, it provides an incomplete assessment of holistic spinal bone health. Paraspinal muscles are essential for spinal stability and movement. This narrative review aims to evaluate the interplay between paraspinal muscle status and lumbar spine BMD, thereby providing a scientific foundation for comprehensive bone health management. Methods: A comprehensive literature search was conducted in PubMed using relevant keywords to identify studies evaluating the functional and morphological interactions between paraspinal muscles and bone mineral density. Discussion: Current evidence demonstrates a significant negative correlation between paraspinal muscle FI and lumbar spine BMD. High FI is identified as an independent risk factor for osteoporotic vertebral fractures and a robust predictor of postoperative complications. The relationship between paraspinal muscle CSA and BMD remains debated. Nevertheless, targeted high-impact and resistance training generate substantial mechanical loading through muscle contraction, providing biological stimuli for trabecular BMD preservation. Conclusions: Evidence highlights a critical synergy between paraspinal muscle status and bone mineral density, with muscle fat infiltration acting as a key marker for bone loss and fracture susceptibility. Integrating these muscle parameters with traditional BMD measurements improves fracture risk stratification and osteoporosis management.<\/jats:p>","DOI":"10.3390\/diagnostics16132010","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:16:44Z","timestamp":1782699404000},"page":"2010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Perspectives on the Relationship Between Paraspinal Muscles and Bone Mineral Density: A Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Hui","family":"Liu","sequence":"first","affiliation":[{"name":"Emergency Department, Seventh Medical Center of PLA General Hospital, Beijing 100162, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1514-0327","authenticated-orcid":false,"given":"Moran","family":"Suo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinuo","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiwen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3561-2691","authenticated-orcid":false,"given":"Xin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4735-1193","authenticated-orcid":false,"given":"Zhonghai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing 100048, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/S0140-6736(18)32112-3","article-title":"Osteoporosis","volume":"393","author":"Compston","year":"2019","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.bone.2006.08.012","article-title":"Sexual dimorphism affects tibia size and shape but not tissue-level mechanical properties","volume":"40","author":"Tommasini","year":"2007","journal-title":"Bone"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1359\/JBMR.050326","article-title":"Relationship between bone morphology and bone quality in male tibias: Implications for stress fracture risk","volume":"20","author":"Tommasini","year":"2005","journal-title":"J. Bone Miner. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.bone.2006.10.028","article-title":"Age-related changes in trabecular bone microdamage initiation","volume":"40","author":"Nagaraja","year":"2007","journal-title":"Bone"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1359\/jbmr.2003.18.11.1947","article-title":"BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures","volume":"18","author":"Stone","year":"2003","journal-title":"J. Bone Miner. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.bone.2007.06.001","article-title":"Hip structural geometry in old and old-old age: Similarities and differences between men and women","volume":"41","author":"Yates","year":"2007","journal-title":"Bone"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1038\/nrrheum.2012.93","article-title":"Recognizing and treating secondary osteoporosis","volume":"8","year":"2012","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jocd.2015.08.004","article-title":"Epidemiology of Vertebral Fractures","volume":"19","author":"Schousboe","year":"2016","journal-title":"J. Clin. Densitom."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/jor.20337","article-title":"Age-related factors affecting the postyield energy dissipation of human cortical bone","volume":"25","author":"Nyman","year":"2007","journal-title":"J. Orthop. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00223-003-0101-x","article-title":"Growth of C57BL\/6 mice and the material and mechanical properties of cortical bone from the tibia","volume":"74","author":"Somerville","year":"2004","journal-title":"Calcif. Tissue Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.exger.2008.10.004","article-title":"Age-related bone loss in the LOU\/c rat model of healthy ageing","volume":"44","author":"Duque","year":"2009","journal-title":"Exp. Gerontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"891","DOI":"10.2460\/ajvr.2004.65.891","article-title":"Comparative assessment of bone mineral measurements obtained by use of dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and chemical-physical analyses in femurs of juvenile and adult dogs","volume":"65","author":"Schneider","year":"2004","journal-title":"Am. J. Vet. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/1096-8644(200011)113:3<389::AID-AJPA9>3.0.CO;2-I","article-title":"Bone mineral density, osteopenia, and osteoporosis in the rhesus macaques of Cayo Santiago","volume":"113","author":"Cerroni","year":"2000","journal-title":"Am. J. Phys. Anthropol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/S0140-6736(02)08761-5","article-title":"Diagnosis of osteoporosis and assessment of fracture risk","volume":"359","author":"Kanis","year":"2002","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1359\/JBMR.040215","article-title":"Risk factors for incident vertebral fractures in men and women: The Rotterdam Study","volume":"19","author":"McCloskey","year":"2004","journal-title":"J. Bone Miner. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2761","DOI":"10.1001\/jama.298.23.2761","article-title":"Long-term risk of incident vertebral fractures","volume":"298","author":"Cauley","year":"2007","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s00198-007-0510-1","article-title":"Rate and circumstances of clinical vertebral fractures in older men","volume":"19","author":"Freitas","year":"2008","journal-title":"Osteoporos. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2258922","DOI":"10.1080\/07853890.2023.2258922","article-title":"The association between morphological characteristics of paraspinal muscle and spinal disorders","volume":"55","author":"Suo","year":"2023","journal-title":"Ann. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00264-022-05621-9","article-title":"Correlation between posterior paraspinal muscle atrophy and lumbar intervertebral disc degeneration in patients with chronic low back pain","volume":"47","author":"Cheng","year":"2023","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shi, L., Yan, B., Jiao, Y., Chen, Z., Zheng, Y., Lin, Y., and Cao, P. (2022). Correlation between the fatty infiltration of paraspinal muscles and disc degeneration and the underlying mechanism. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05466-8"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/j.spinee.2017.04.025","article-title":"Lumbar muscle structure and function in chronic versus recurrent low back pain: A cross-sectional study","volume":"17","author":"Goubert","year":"2017","journal-title":"Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1080\/13685538.2021.1878130","article-title":"Age-related degeneration of lumbar muscle morphology in healthy younger versus older men","volume":"23","author":"Dallaway","year":"2020","journal-title":"Aging Male"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/S0140-6736(10)62349-5","article-title":"Osteoporosis: Now and the future","volume":"377","author":"Rachner","year":"2011","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/00007632-199116020-00009","article-title":"Correlations between vertebral regional bone mineral density (rBMD) and whole bone fracture load","volume":"16","author":"Cody","year":"1991","journal-title":"Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.acra.2017.06.013","article-title":"Thoracic Quantitative Computed Tomography (QCT) Can Sensitively Monitor Bone Mineral Metabolism: Comparison of Thoracic QCT vs Lumbar QCT and Dual-energy X-ray Absorptiometry in Detection of Age-relative Change in Bone Mineral Density","volume":"24","author":"Mao","year":"2017","journal-title":"Acad. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000052800","article-title":"Influence of muscle strength and body weight and composition on regional bone mineral density in healthy women aged 60 years and over","volume":"47","author":"Blain","year":"2001","journal-title":"Gerontology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1359\/jbmr.040916","article-title":"Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites","volume":"19","author":"Riggs","year":"2004","journal-title":"J. Bone Miner. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1359\/jbmr.071020","article-title":"A population-based assessment of rates of bone loss at multiple skeletal sites: Evidence for substantial trabecular bone loss in young adult women and men","volume":"23","author":"Riggs","year":"2008","journal-title":"J. Bone Miner. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1002\/jbmr.5650090904","article-title":"Lifestyle factors and bone density in the elderly: Implications for osteoporosis prevention","volume":"9","author":"Nguyen","year":"1994","journal-title":"J. Bone Miner. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00223-001-1037-7","article-title":"Effects of age and menopause on spinal bone mineral density in Japanese women: A ten-year prospective study","volume":"70","author":"Zhang","year":"2002","journal-title":"Calcif. Tissue Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/jbmr.5650020205","article-title":"Computer modeling and analysis of cross-sectional bone density studies with respect to age and the menopause","volume":"2","author":"Sambrook","year":"1987","journal-title":"J. Bone Miner. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1080\/09513590.2021.1925243","article-title":"Effects of anthropometric parameters on bone mineral density in women: From perimenopause to old age","volume":"37","author":"Matos","year":"2021","journal-title":"Gynecol. Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00223-011-9564-3","article-title":"Effects of increasing age, dosage, and duration of PTH treatment on BMD increase--a meta-analysis","volume":"90","author":"Schwarz","year":"2012","journal-title":"Calcif. Tissue Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/sms.12301","article-title":"Do variations in paraspinal muscle morphology and composition predict low back pain in men?","volume":"25","author":"Fortin","year":"2015","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2562957","DOI":"10.1155\/2017\/2562957","article-title":"The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain","volume":"2017","author":"Kalichman","year":"2017","journal-title":"BioMed Res. Int."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mandelli, F., N\u00fcesch, C., Zhang, Y., Halbeisen, F., Sch\u00e4ren, S., M\u00fcndermann, A., and Netzer, C. (2021). Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.656487"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1007\/s40520-022-02149-1","article-title":"The effect of ageing on fat infiltration of thigh and paraspinal muscles in men","volume":"34","author":"Engelke","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"108904","DOI":"10.1016\/j.ejrad.2020.108904","article-title":"Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI","volume":"125","author":"Burian","year":"2020","journal-title":"Eur. J. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"19497","DOI":"10.1038\/s41598-019-56186-4","article-title":"Longitudinal Analysis of Paraspinal Muscle Cross-Sectional Area During Early Adulthood\u2014A 10-Year Follow-Up MRI Study","volume":"9","author":"Oura","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.21037\/qims-19-835","article-title":"Age-related fatty infiltration of lumbar paraspinal muscles: A normative reference database study in 516 Chinese females","volume":"10","author":"Peng","year":"2020","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.spinee.2015.07.001","article-title":"The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis","volume":"16","author":"Yagi","year":"2016","journal-title":"Spine J."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Xia, W., Fu, H., Zhu, Z., Liu, C., Wang, K., Xu, S., and Liu, H. (2019). Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2837-0"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Han, G., Zou, D., Liu, Z., Zhang, B., Gong, C., Zhou, S., Li, W., Sun, Z., and Li, W. (2022). Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05178-z"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3233\/BMR-140515","article-title":"Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis","volume":"28","author":"Wang","year":"2015","journal-title":"J. Back. Musculoskelet. Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00586-013-3148-z","article-title":"Image changes of paraspinal muscles and clinical correlations in patients with unilateral lumbar spinal stenosis","volume":"23","author":"Chen","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3563","DOI":"10.2147\/JPR.S376575","article-title":"Radiological Changes of Paraspinal Muscles: A Comparative Study of Patients with Isthmic Spondylolisthesis, Patients with Degenerative Lumbar Spondylolisthesis, and Healthy Subjects","volume":"15","author":"Li","year":"2022","journal-title":"J. Pain Res."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Liu, C., Xue, J., Liu, J., Ma, G., Moro, A., Liang, T., Zeng, H., Zhang, Z., Xu, G., and Lu, Z. (2021). Is there a correlation between upper lumbar disc herniation and multifidus muscle degeneration? A retrospective study of MRI morphology. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-03970-x"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1007\/s005860000190","article-title":"CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects","volume":"9","author":"Danneels","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3344\/kjp.2021.34.4.454","article-title":"Factors associated with paravertebral muscle cross-sectional area in patients with chronic low back pain","volume":"34","author":"Cankurtaran","year":"2021","journal-title":"Korean J. Pain"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1002\/ca.23776","article-title":"The relationship between muscle size, obesity, body fat ratio, pain and disability in individuals with and without nonspecific low back pain","volume":"34","year":"2021","journal-title":"Clin. Anat."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S1050-6411(99)00020-6","article-title":"Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes","volume":"10","author":"Onishi","year":"2000","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S0003-9993(96)90108-2","article-title":"Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects","volume":"77","author":"Ng","year":"1996","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1097\/00007632-199905010-00009","article-title":"Factors in the reproducibility of electromyographic power spectrum analysis of lumbar paraspinal muscle fatigue","volume":"24","author":"Nargol","year":"1999","journal-title":"Spine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1152\/jappl.1990.68.3.1177","article-title":"Electromyogram power spectra frequencies associated with motor unit recruitment strategies","volume":"68","author":"Solomonow","year":"1990","journal-title":"J. Appl. Physiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/jor.1100150614","article-title":"Fibre type characteristics of the lumbar paraspinal muscles in normal healthy subjects and in patients with low back pain","volume":"15","author":"Mannion","year":"1997","journal-title":"J. Orthop. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00198-013-2482-7","article-title":"The functional muscle-bone unit in subjects of varying BMD","volume":"25","author":"Ma","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s11657-019-0639-5","article-title":"Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine","volume":"14","author":"Zhao","year":"2019","journal-title":"Arch. Osteoporos."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1007\/s00223-022-00944-6","article-title":"Correlation Between Bone Mineral Density (BMD) and Paraspinal Muscle Fat Infiltration Based on QCT: A Cross-Sectional Study","volume":"110","author":"Li","year":"2022","journal-title":"Calcif. Tissue Int."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"100447","DOI":"10.1016\/j.ejro.2022.100447","article-title":"Associations between paraspinal muscles fatty infiltration and lumbar vertebral bone mineral density\u2014An investigation by fast kVp switching dual-energy CT and QCT","volume":"9","author":"Zhou","year":"2022","journal-title":"Eur. J. Radiol. Open"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"20210371","DOI":"10.1259\/bjr.20210371","article-title":"Muscle fat infiltration but not muscle cross-sectional area is independently associated with bone mineral density at the lumbar spine","volume":"95","author":"Yang","year":"2022","journal-title":"Br. J. Radiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"538","DOI":"10.3906\/sag-1809-48","article-title":"The association of reduced bone density with paraspinal muscle atrophy and adipose tissue in geriatric patients: A cross-sectional CT study","volume":"49","author":"Ekin","year":"2019","journal-title":"Turk. J. Med. Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s11914-020-00599-y","article-title":"Muscle, Bone, and Fat Crosstalk: The Biological Role of Myokines, Osteokines, and Adipokines","volume":"18","author":"Kirk","year":"2020","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.arr.2015.03.002","article-title":"Muscle and bone, two interconnected tissues","volume":"21","author":"Tagliaferri","year":"2015","journal-title":"Ageing Res. Rev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.spinee.2023.11.007","article-title":"MRI-based vertebral bone quality score is a comprehensive index reflecting the quality of bone and paravertebral muscle","volume":"24","author":"Li","year":"2024","journal-title":"Spine J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s00330-022-08979-x","article-title":"Greater bone marrow fat and myosteatosis are associated with lower vBMD but not asymptomatic vertebral fracture","volume":"33","author":"Wang","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1007\/s00774-022-01311-z","article-title":"Relationship between oseteoporosis with fatty infiltration of paraspinal muscles based on QCT examination","volume":"40","author":"Li","year":"2022","journal-title":"J. Bone Miner. Metab."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.29271\/jcpsp.2022.09.1137","article-title":"Relationship between the Properties of Paraspinal Muscles and Bone Mineral Density in Osteoporotic Patients","volume":"32","author":"Tekin","year":"2022","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"108867","DOI":"10.1016\/j.ejrad.2020.108867","article-title":"Assessment of paraspinal muscle characteristics, lumbar BMD, and their associations in routine multi-detector CT of patients with and without osteoporotic vertebral fractures","volume":"125","author":"Sollmann","year":"2020","journal-title":"Eur. J. Radiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.jocd.2022.04.001","article-title":"Computed Tomography Measured Psoas Cross Sectional Area Is Associated With Bone Mineral Density Measured by Dual Energy X-Ray Absorptiometry","volume":"25","author":"Touban","year":"2022","journal-title":"J. Clin. Densitom."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1007\/s00198-022-06430-x","article-title":"The association between lumbar paraspinal muscle functional cross-sectional area on MRI and regional volumetric bone mineral density measured by quantitative computed tomography","volume":"33","author":"Chiapparelli","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Han, G., Zou, D., Liu, Z., Zhou, S., Li, W., Gong, C., Sun, Z., and Li, W. (2022). Paraspinal muscle characteristics on MRI in degenerative lumbar spine with normal bone density, osteopenia and osteoporosis: A case-control study. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05036-y"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Hummel, J., Engelke, K., Freitag-Wolf, S., Yilmas, E., Bartenschlager, S., Sigurdsson, S., Gudnason, V., Gl\u00fcer, C.C., and Chaudry, O. (2025). Trabecular texture and paraspinal muscle characteristics for prediction of first vertebral fracture: A QCT analysis from the AGES cohort. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1566424"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"112654","DOI":"10.1016\/j.exger.2024.112654","article-title":"Enhancing fracture risk indication: The impact of bone load index and muscle fat infiltration on vertebral compression fracture","volume":"199","author":"Jiang","year":"2025","journal-title":"Exp. Gerontol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1177\/10538127251340350","article-title":"The effect of paraspinal muscle morphology on the development of osteoporotic lumbar vertebral fractures","volume":"38","author":"Tekin","year":"2025","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1177\/21925682241274371","article-title":"Integration of Spinal Musculoskeletal System Parameters for Predicting OVCF in the Elderly: A Comprehensive Predictive Model","volume":"15","author":"Wang","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1186\/s13018-024-05290-x","article-title":"Risk factors for secondary vertebral compression fracture after percutaneous vertebral augmentation: A single-centre retrospective study","volume":"19","author":"Tang","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Yang, W., Zou, K., Lin, X., Yang, Y., Chen, T., Wu, X., Wang, X., Liu, Q., Huang, C., and Su, W. (2025). Risk factors for new vertebral fractures after percutaneous vertebroplasty or percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1514894"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"124325","DOI":"10.1016\/j.wneu.2025.124325","article-title":"Paraspinal Muscle Fat Infiltration Predicts Vertebral Refracture After Kyphoplasty: Development and Validation of a Novel Nomogram Model","volume":"201","author":"Zhuo","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1002\/jbmr.5650040320","article-title":"Muscle strength, physical fitness, and weight but not age predict femoral neck bone mass","volume":"4","author":"Pocock","year":"1989","journal-title":"J. Bone Miner. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1007\/s00223-013-9836-1","article-title":"Gender-specific associations between physical functioning, bone quality, and fracture risk in older people","volume":"94","author":"Furrer","year":"2014","journal-title":"Calcif. Tissue Int."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1002\/jbmr.4634","article-title":"Density and Fat Fraction of the Psoas, Paraspinal, and Oblique Muscle Groups Are Associated With Lumbar Vertebral Bone Mineral Density in a Multi-Ethnic Community-Living Population: The Multi-Ethnic Study of Atherosclerosis","volume":"37","author":"Gurusamy","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1007\/s00198-020-05484-z","article-title":"Changes in spinal bone density, back muscle size, and visceral adipose tissue and their interaction following a multi-component exercise program in older men: Secondary analysis of an 18-month randomized controlled trial","volume":"31","author":"Turcotte","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Liu, S., Xia, X., Nie, Y., Huang, M., Meng, L., and Du, J. (2024). Musculoskeletal model predicted paraspinal loading may quick estimate the effect of exercise on spine BMD. Front. Bioeng. Biotechnol., 12.","DOI":"10.3389\/fbioe.2024.1464067"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2010\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:55:06Z","timestamp":1782701706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":84,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132010"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132010","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]}}}