Complementing Bone Mineral Density Assessment: DXA-Based Radiomics for Vertebral Evaluation in Older Adults

Background and Objectives: Dual-energy X-ray absorptiometry (DXA) provides areal bone mineral density (BMD) and T-scores but does not fully characterize image texture. This study examined the relationship between lumbar T-score and DXA-derived Shannon entropy, a first-order descriptor of image-intensity heterogeneity, and whether entropy differed across densitometric categories in older adults. Materials and Methods: This cross-sectional study included 271 community-dwelling adults aged ≥60 years who underwent lumbar DXA. Regions of interest from L1–L4 were segmented, gray levels were quantized to 8 bits, and entropy was calculated for each evaluable vertebra and averaged at the participant level. Pearson correlation, one-way ANOVA with Tukey post hoc testing, effect sizes, tertile-based discordance analysis, and multiple linear regression were applied.