Incidence of New Fractures in Patients Treated with Kyphoplasty/Vertebroplasty or Conservative Methods

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a common cause of morbidity in the elderly, often resulting in pain, reduced mobility, and diminished quality of life. Treatment options include conservative management, vertebroplasty (VP), and kyphoplasty (KP). This study aimed to compare the clinical outcomes and complication rates of patients treated with kyphoplasty/vertebroplasty versus conservative methods and identify risk factors associated with the development of new fractures. Materials and Methods: This retrospective cohort study included patients diagnosed with OVCFs who were treated either surgically (KP/VP) or conservatively between January 2020 and January 2025. Inclusion criteria encompassed vertebral height loss on CT, STIR hyperintensity on MRI, and a T-score below -2.5. Patients were followed for at least one year. Clinical evaluations included pain scores (VAS), functional status (ODI), and quality of life assessments. Complications and new fracture rates were recorded. Logistic regression analysis was performed to identify risk factors influencing fracture recurrence. Results: A total of 132 patients were analyzed: 65 in the KP/VP group and 67 in the conservative treatment group. The KP/VP group achieved better postoperative pain results (3.2 ± 1.0 vs. 4.0 ± 1.2) with a significant difference of -0.8 (95% CI: -1.2 to -0.4, p = 0.032) and better mobility results (ODI: 4.5 ± 0.8 vs. 3.9 ± 0.9) with a significant difference of 0.6 (95% CI: 0.3-0.9, p = 0.047) and improved quality of life scores (6.7 ± 1.1 vs. 5.9 ± 1.3) with a significant difference of 0.8 (95% CI: 0.4-1.2, p = 0.041). The incidence of new fractures was similar between groups (15.4% vs. 17.9%, p = 0.678). Overall complication rates were 7.7% in the KP/VP group versus 11.9% in the conservative group (p = 0.435). The results from logistic regression analysis showed that age (adjusted OR: 2.48, 95% CI: 1.20-5.13), low bone mineral density (adjusted OR: 0.31, 95% CI: 0.15-0.63), and cement leakage (adjusted OR: 3.10, 95% CI: 1.21-7.99) were identified as risk factors for new fractures. The study found that outdoor activity (adjusted OR: 0.38, 95% CI: 0.20-0.73) and anti-osteoporosis treatment (adjusted OR: 0.17, 95% CI: 0.04-0.79) acted as protective factors against new fractures. The KP/VP group required half the time to recover from their injuries because they used their braces for 3.0 ± 0.5 months instead of 6.0 ± 1.0 months (p < 0.001). Conclusions: Kyphoplasty and vertebroplasty were more effective than conservative treatment in improving pain, mobility, and quality of life in patients with OVCFs. Although the incidence of new fractures did not differ significantly between groups, surgical treatment demonstrated lower complication rates and significantly faster recovery, as evidenced by reduced brace use duration. These findings support the use of KP/VP as a viable option for managing OVCFs in appropriately selected patients.