Risk factors for new vertebral fracture after percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures (OVCFs): an updated systematic review and meta-analysis.

Purpose: Osteoporotic vertebral compression fractures (OVCFs) are common in older persons, and percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are effective minimally invasive treatments. This systematic review and meta-analysis aim to update knowledge on risk factors associated with NVCF after these procedures.

Methods: PubMed, EMBASE, and the Cochrane Library were searched to December 2023 for studies evaluating risk factors for NVCF after PVP and PKP, using the following keywords: "osteoporotic vertebral compression fractures," "percutaneous vertebral augmentation," "vertebroplasty", "kyphoplasty," "new vertebral fracture," and "risk factor". Eligible studies included randomized controlled trials (RCTs), prospective and retrospective studies, and case-control studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to derive summary effects. Heterogeneity among the studies was assessed using the I² statistic.

Results: Fifteen studies including a total of 6,546 patients were analyzed. Significant risk factors for new vertebral fractures (NVCF) following PVP and PKP were older age (adjusted OR [aOR] = 1.08, 95% CI: 1.01-1.15), female sex (aOR = 2.11, 95% CI: 1.60-2.79), a higher number of treated vertebrae (aOR = 2.27, 95% CI: 1.18-4.35), and cement leakage (aOR = 3.43, 95% CI: 2.17-5.41). No statistical significances on the associations between bone mineral density (BMD), body mass index (BMI) with NVCF were observed.

Conclusion: Significant risk factors for NVCF after PVP and PKP include older age, female sex, higher number of treated vertebrae, and cement leakage. The findings highlight the importance of careful patient selection to minimize the risk of NVCF.

Level of evidence: IV.