Effect of zoledronic acid on recurrent vertebral fractures after percutaneous vertebroplasty

To evaluate the effect of zoledronic acid (ZA) infusion after percutaneous vertebroplasty (PVP) on the recurrence of osteoporotic vertebral compression fractures (OVCFs).

A retrospective analysis included 233 elderly OVCF patients from Zhongshan People's Hospital (January 2021-July 2025) who experienced a secondary fracture after initial PVP with or without ZA. Patients were divided into a control group (PVP alone, n = 112) and a combination group (PVP plus ZA, n = 121). Intergroup comparisons covered vertebral status, pain intensity, bone metabolism markers, lumbar bone mineral density (BMD), and time to second fracture at both initial and subsequent admissions.

Cox regression analysis indicated that postoperative ZA, number of vertebral fractures, and bone cement volume significantly influenced time to subsequent fracture (P < 0.05). Adjuvant ZA, single-level fracture, and moderate cement volume were associated with delayed recurrence. At secondary fracture, the combination group showed significantly higher lumbar BMD and longer fracture time interval than controls (P < 0.001). Serum levels of procollagen type 1 N-terminal propeptide (PINP), β-Crosslaps (β-CTX), and osteocalcin (OC) were significantly lower in the combination group compared to both baseline and control levels at secondary fracture (P < 0.001). In contrast, parathyroid hormone (PTH) levels were significantly elevated relative to both initial values and concurrent controls (P < 0.001).

Post-PVP ZA administration improved BMD, delayed secondary fractures, and reduced bone turnover in OVCF patients, thereby promoting better clinical outcomes. An appropriate bone cement volume also contributed to prolonged fracture-free intervals.