RISK FACTORS FOR RECURRENT VERTEBRAL COMPRESSION FRACTURES AFTER PERCUTANEOUS VERTEBROPLASTY IN OSTEOPOROTIC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Recurrent vertebral compression fractures (rVCFs) after percutaneous vertebroplasty (PVP) impair quality of life in osteoporotic patients, yet their risk factors remain debated, necessitating a systematic evaluation. Objective. To synthesize clinical data and quantitatively assess the impact of demographic, morphometric, and technical factors on rVCF incidence postPVP. Methods. A search was conducted in PubMed, Scopus, Medline, and Google Scholar (2010–2024) using MeSH terms: «vertebroplasty», «compression fractures», «osteoporosis», «risk factors», «recurrence». Twenty cohort studies (7,923 patients) were included. Continuous variables were pooled using the Sidik–Jonkman random-effects model (Cohen’s d), and categorical variables using the Paule–Mandel model (odds ratio, OR). Heterogeneity was assessed with I² and prediction intervals; sensitivity analyses were performed. Evidence certainty was evaluated using GRADE. Results. Significant risk factors for rVCFs included absence of anti-osteoporotic therapy (AOT) (OR = 1.97, I² = 40 %), cement leakage (OR = 1.92, I² = 68 %), and low bone mineral density (BMD) (d = –0.55, I² = 72 %), with moderate GRADE certainty. Female sex (OR = 1.30, I² = 39 %) and older age (d = 0.24, I² = 62 %) showed weaker associations with low certainty. Cement volume, body mass index, kyphotic angle, its correction, vertebral height restoration, and thoracolumbar junction involvement were not associated with rVCFs. Conclusions. The most significant rVCF risk factors are absence of AOT, cement leakage, and low BMD, nearly doubling the risk. Female sex increases risk by approximately one-third, and older age has a minor effect. These findings highlight the importance of AOT and technical precision in PVP to prevent rVCFs.