To investigate the application value of dual-energy X-ray absorptiometry (DXA) combined with magnetic resonance imaging (MRI) in evaluating the fracture severity and predicting the functional prognosis in patients with osteoporotic vertebral compression fracture (OVCF).

70 patients with OVCF admitted to our hospital from December 2023 to July 2025 were included. All patients underwent DXA and MRI examinations, recording imaging parameters such as bone mineral density (BMD) values, T values, vertebral compression rate, bone marrow edema volume, and signal intensity ratio. According to the Genant semi quantitative method, the patients were divided into mild group, moderate group, and severe group. Compare the differences in imaging parameters, visual analogue scale (VAS) scores, and Oswestry disability index (ODI) among patients with different fracture severity. Pearson analysis was used to evaluate the correlation between imaging parameters, VAS scores, and ODI. According to the ODI improvement rate at 6 months after treatment, the patients were divided into good prognosis group and poor prognosis group. Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each indicator and combined model for poor prognosis.

With the fracture severity increased, the BMD and T values gradually decreased, the vertebral compression rate, bone marrow edema volume, signal intensity ratio, VAS scores, and ODI gradually increased in the three groups, the differences were statistically significant (P<0.05). Pearson correlation analysis showed that BMD values were negatively correlated with VAS scores and ODI (P<0.05), the bone marrow edema volume was positively correlated with VAS scores and ODI (P<0.05). Multivariate logistic regression analysis indicated that T values (OR=2.416, 95%CI: 1.213~4.798), vertebral compression ratio (OR=3.121, 95%CI: 1.472~6.618), and bone marrow edema volume (OR=2.183, 95%CI: 1.134~4.209) were independent risk factors for poor prognosis (P<0.05). ROC curve analysis showed that the area under curve (AUC) of T values, vertebral compression ratio, and bone marrow edema volume for predicting the poor prognosis were 0.763, 0.781, and 0.752, while the AUC of the combined model was 0.892.

T values, vertebral compression rate, and bone marrow edema volume are closely related to the fracture severity and functional prognosis in patients with OVCF. DXA combined with MRI can comprehensively evaluate OVCF from multiple dimensions such as bone mass, vertebral structure, and bone marrow response, which is helpful in predicting the prognosis, and has important value in guiding individualized clinical treatment.