Risk factors analysis for refracture after vertebroplasty in osteoporotic thoracolumbar vertebral fractures

Osteoporotic vertebral compression fractures (OVCFs) are common in patients with osteoporosis and have a significant impact on quality of life. Vertebroplasty is a common treatment, but the risk of postoperative refracture remains a complex issue. Identification of associated risk factors is essential to improve patient prognosis.

This retrospective cohort study included 180 patients aged 60 years and older with osteoporotic thoracolumbar fractures who underwent vertebroplasty between January 2021 and September 2022. Several variables were collected from the electronic medical record system. Univariate and multivariate Cox regression models were used to identify independent risk factors for refracture. Kaplan-Meier survival analysis was used to calculate non-refracture survival, and ROC curves were used to assess predictive ability.

During the follow-up period ranging from 12 to 33 months (mean: 19.28 ± 7.84 months), 24 patients experienced vertebral refracture. Univariate and multivariate Cox regression analyses identified four independent risk factors: bone cement distribution pattern, bone mineral density (BMD), anterior vertebral height ratio (AVHR), and Cobb angle restoration. The compact type of bone cement distribution, lower BMD, higher AVHR, and greater Cobb angle restoration increased the risk of refracture. The combined prediction of these factors had a higher predictive power (AUC = 0.89).

Bone cement distribution pattern, BMD, AVHR, and Cobb angle restoration are important risk factors for refracture after vertebroplasty in osteoporotic thoracolumbar fractures. The combined assessment of these factors can better predict the risk of refracture.