Risk Factors for Osteoporotic Vertebral Compression Fracture and Evaluation of Clinical Outcomes of Minimally Invasive Vertebral Augmentation

Abstract

Study Design: Retrospective study and prospective cohort study. Objective: Osteoporotic vertebral compression fracture (OVCF) is a frequent and disabling complication of osteoporosis. This study aimed to identify independent risk factors for OVCF, develop and validate a predictive model, and evaluate a risk-stratified surgical strategy comparing percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Methods: The study consisted of 3 stages. A retrospective cohort of 316 patients was used to identify risk factors and construct a predictive model, which was externally validated in an independent cohort of 274 patients. A prospective cohort of 206 OVCF patients was then enrolled to compare clinical and radiographic outcomes of PVP and PKP. Patients with a predicted risk score >0.5 were classified as high risk and preferentially treated with PKP. Pain, functional outcomes, radiographic parameters, and complications were evaluated preoperatively and at 1 week, 3 months, and 6 months postoperatively. Results: Multivariate analysis identified age ≥70 years, body mass index <20 kg/m2, bone mineral density T-score ≤−3.0, history of falls, and 25-hydroxyvitamin D deficiency as independent risk factors. The predictive model showed good calibration and clinical utility. Both PVP and PKP significantly improved pain and function. Within the risk-stratified strategy, PKP was associated with greater improvements in pain relief, functional recovery, and radiographic restoration, as well as lower rates of cement leakage and refracture. Conclusion: A validated predictive model for OVCF was established and may support individualized surgical decision-making. Risk-stratified use of PKP appears to provide superior short- to mid-term outcomes in high-risk patients.