Risk factors for newly developed osteoporotic vertebral compression fractures after treatment of osteoporotic vertebral compression fractures introduction and aim

Osteoporotic vertebral compression fractures (OVCFs) are a significant cause of pain and disability in the elderly population. Kyphoplasty is a widely preferred minimally invasive technique due to its ability to restore vertebral height and its lower risk of cement leakage compared to vertebroplasty. However, the development of new vertebral fractures following kyphoplasty remains a clinically important issue, and the associated risk factors are not yet clearly defined. This study aims to identify the potential risk factors associated with the development of new fractures after kyphoplasty. Materials and Methods This retrospective study included 139 patients who underwent kyphoplasty in our clinic between 2019 and 2023 and met the inclusion criteria. Patients were divided into two groups: those who developed new vertebral fractures postoperatively (n=33) and those who did not (n=106). The groups were compared based on variables such as age, sex, fracture level, bone mineral density (T and Z scores), osteoporosis treatment status, body mass index, presence of hypertension and diabetes, cement parameters (dose, leakage, distribution and dispersion), anterior vertebral height, Cobb and kyphotic angles, Visual Analog Scale (VAS) scores, and sagittal index. Results The group with new fractures had a significantly higher mean age and lower T and Z scores. Fractures were more frequently observed at the T12 and L1 vertebral levels in this group, which was statistically significant. Additionally, insufficient anterior vertebral height restoration and suboptimal cement distribution were found to be associated with the occurrence of new fractures. Conclusion The findings of this study indicate that advanced age, low bone mineral density, and fractures located at T12 and L1 are significant risk factors for new vertebral fractures following kyphoplasty. Moreover, inadequate cement distribution and poor restoration of vertebral height may contribute to fracture recurrence. Identifying high-risk patients, optimizing surgical techniques, and ensuring effective osteoporosis management are crucial to prevent subsequent fractures after kyphoplasty. Keywords: Osteoporotic Vertebral Fracture, Risk Factors, Percutaneous Kyphoplasty, Percutaneous Vertebroplasty, New Fracture Development, PMMA