Osteoporosis, a condition causing weakened bones and increased fracture risk, is typically diagnosed using imaging tests like DEXA and REMS. However, conflicting results between these tests can create confusion for patients and doctors. The Vertebral Bone Quality (VBQ) score, derived from lumbar spine MRIs, offers a promising secondary tool to clarify bone health status. It provides an additional layer of assessment to help guide treatment decisions, particularly when discrepancies arise.