Diagnostic Perspectives on the Relationship Between Paraspinal Muscles and Bone Mineral Density: A Narrative Review

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.