Systemic Physiological Impact on Cervical Bone Quality Measurements: A Comparative Analysis of Cervical Vertebral Bone Quality Scores and Hounsfield Units

OBJECTIVES: Cervical vertebral bone quality (C-VBQ) scores and cervical Hounsfield units (C-HU) demonstrate significant potential for bone quality assessment. However, research on the influence of physiological factors on these metrics remains limited. This study aims to: quantify segment- and gender-specific associations between various physiological factors and both measures. METHODS: This retrospective study analyzed 512 patients with cervical spondylotic myelopathy from January 2023 to January 2024, with a mean age of 63.04 ± 8.86 years. Differences between male and female groups were compared using independent sample t-tests, Welch's corrected t-test, Mann-Whitney U tests, and chi-square tests, as appropriate for variable type and distribution. Pearson and Spearman correlation analyses, as well as multiple linear regression, were performed to clarify the associations between physiological factors and these two measurement methods across different cervical segments and genders. RESULTS: At the C4/5 segment, the C-VBQ score showed the strongest correlations with age, fasting blood glucose (FBG), glycated albumin (GA), activated partial thromboplastin time (APTT), conjugated bilirubin (CB), unconjugated bilirubin, total bilirubin, and serum calcium, while C-HU correlated most strongly with age, serum phosphorus, alkaline phosphatase (ALP), CB, GA, and APTT (all p < 0.05). Notably, the correlations of age, CB, and GA with both measurement methods were stronger in females than in males. Moreover, the correlations of CB and GA with the C-VBQ score were stronger than those with C-HU. Multiple linear regression analysis revealed that age (B = 0.020), CB (B = 0.169), GA (B = 0.082), and serum calcium (B = -0.784) were independent predictors of the C-VBQ score (all p < 0.01). Moreover, age (B = -2.701), ALP (B = -0.569), CB (B = -6.533), and GA (B = -7.069) were independent predictors of C-HU. CONCLUSIONS: The associations of bilirubin metabolism and glucose metabolism indicators with both methods were more pronounced at the C4/5 segment and among female populations, and the C-VBQ score appeared to be more sensitive.