Welcome to Francis Academic Press

International Journal of Frontiers in Medicine, 2026, 8(1); doi: 10.25236/IJFM.2026.080102.

Research Progress on Risk Factors for Post-operative Re-fracture after Osteoporotic Vertebral Compression Fracture Surgery

Author(s)

Keyu Zeng1, Xingda Cai1, Weijian Zhang1, Dingsheng Zha1,2

Corresponding Author:
Dingsheng Zha
Affiliation(s)

1Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510623, China

2Department of Orthopedics, The Affiliated Shunde Hospital of Jinan University, Foshan, 528305, China

Abstract

Osteoporotic vertebral compression fractures (OVCF) are common among the elderly. [1]Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) can quickly relieve pain, but the incidence of refracture after surgery will increase, which will affect the prognosis. [2]This article reviews the latest progress of refracture after OVCF surgery, pointing out that refracture is not just a single factor but a result of the interaction of multiple factors, such as patients, techniques, images, and management. [3]The core mechanisms include changes in biomechanics, reduced bone quality, and impaired healing. [4]Based on this, the article emphasizes the importance of individualized risk assessment and proposes the integration of imaging, biomechanical, and clinical data to construct predictive models, aiming to optimize surgical strategies and improve patients' long-term health outcomes.

Keywords

Osteoporotic Vertebral Compression Fracture (OVCF); Re-fracture; Vertebroplasty; Risk Factors

Cite This Paper

Keyu Zeng, Xingda Cai, Weijian Zhang, Dingsheng Zha. Research Progress on Risk Factors for Post-operative Re-fracture after Osteoporotic Vertebral Compression Fracture Surgery. International Journal of Frontiers in Medicine (2026), Vol. 8, Issue 1: 14-21. https://doi.org/10.25236/IJFM.2026.080102.

References

[1] WIKLUND P, BUCHEBNER D, GEIJER M. Vertebral compression fractures at abdominal CT: underdiagnosis, undertreatment, and evaluation of an AI algorithm [J]. J Bone Miner Res, 2024, 39(8): 1113-1119.

[2] LI J, XIE Y, SUN S, et al. Regional differences in bone mineral density biomechanically induce a higher risk of adjacent vertebral fracture after percutaneous vertebroplasty: a case-comparative study [J]. Int J Surg, 2023, 109(3): 352-363.

[3] MARSELOU E, KELEKIS A, DIMITRIADIS Z, et al. Risk factors for refracture or new vertebral compression fractures after percutaneous vertebroplasty: a systematic review and meta-analysis [J]. Osteoporos Int, 2025, 36(8): 1297-1311.

[4] YU P, TANG Z, CHANG W, et al. Degenerative scoliosis may trigger higher incidence of adjacent vertebral fractures following percutaneous vertebroplasty: a clinical evidence-based biomechanical research [J]. Osteoporos Int, 2026, 37(1): 133-143.

[5] THOMAS T, TUBACH F, BIZOUARD G, et al. The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study [J]. J Bone Miner Res, 2022, 37(10): 1811-1822.

[6] LYU F F, ZHANG M, DENG Y F, et al. Incidence and predictors of residual back pain after percutaneous vertebral augmentation in osteoporotic vertebral compression fracture: a systematic review and meta analysis [J]. Osteoporos Int, 2025, 36(10): 1781-1794.

[7] KUMAR S, WANG M, KIM A S, et al. Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures [J]. J Bone Miner Res, 2025, 40(9): 1017-1034.

[8] BURCKHARDT P, FAOUZI M, BUCLIN T, et al. Fractures After Denosumab Discontinuation: A Retrospective Study of 797 Cases [J]. J Bone Miner Res, 2021, 36(9): 1717-1728.

[9] OHMAN-MAGI C, HOLUB O, WU D, et al. Density and mechanical properties of vertebral trabecular bone-A review [J]. JOR Spine, 2021, 4(4): e1176.

[10] SOLLMANN N, LOFFLER M T, EL HUSSEINI M, et al. Automated Opportunistic Osteoporosis Screening in Routine Computed Tomography of the Spine: Comparison With Dedicated Quantitative CT [J]. J Bone Miner Res, 2022, 37(7): 1287-1296.

[11] WAN S, WU Z, LI H, et al. Poor bony density can independently trigger higher incidence of adjacent vertebral fracture after percutaneous vertebralplasty: a mono-center retrospective study [J]. Langenbecks Arch Surg, 2025, 410(1): 87.

[12] MATSUMOTO K, HOSHINO M, SAWADA H, et al. The Risk of Adjacent Vertebral Fracture Following Balloon Kyphoplasty in Patients With Previous Adjacent Vertebral Fracture [J]. Cureus, 2024, 16(10): e72627.

[13] HAN C S, HANCOCK M J, DOWNIE A, et al. Red flags to screen for vertebral fracture in people presenting with low back pain [J]. Cochrane Database Syst Rev, 2023, 8(8): Cd014461.

[14] WESTERHOFF M, GYFTOPOULOS S, DANE B, et al. Deep Learning-based Opportunistic CT Osteoporosis Screening and the Establishment of Normative Values [J]. Radiology, 2025, 317(2): e250917.

[15] WOLFEL E M, SCHMIDT F N, VOM SCHEIDT A, et al. Dimorphic Mechanisms of Fragility in Diabetes Mellitus: the Role of Reduced Collagen Fibril Deformation [J]. J Bone Miner Res, 2022, 37(11): 2259-2276.

[16] CHANG Y, CHI K Y, CHEN C M, et al. Association between SGLT2 inhibitor use and the risk of vertebral augmentation after initial osteoporotic vertebral fracture in patients with type 2 diabetes [J]. Osteoporos Int, 2026.

[17] HSU S, BANSAL N, DENBURG M, et al. Risk factors for hip and vertebral fractures in chronic kidney disease: the CRIC study [J]. J Bone Miner Res, 2024, 39(4): 433-442.

[18] WU M, LI H, SUN X, et al. Aerobic exercise prevents renal osteodystrophy via irisin-activated osteoblasts [J]. JCI Insight, 2025, 10(5).

[19] LIN Y H, LIN J, XU J Y, et al. What Risk Factors Are Associated With Recurrent Osteoporotic Vertebral Compression Fractures After Percutaneous Vertebral Augmentation? A Meta-analysis [J]. Clin Orthop Relat Res, 2025, 483(8): 1528-1539.

[20] NGUYEN B T T, NGUYEN T T, KUO Y J, et al. Impact of sarcopenia on outcomes following vertebral augmentation for osteoporotic vertebral compression fracture: a systematic review and meta-analysis [J]. Asian Spine J, 2025, 19(3): 476-489.

[21] WEN Q, WANG J, TAN G, et al. Association between lumbar disc degeneration at L4-L5 level and atrophy of paraspinal muscles and gluteus medius: a cross-sectional study using 3T quantitative magnetic resonance imaging [J]. BMC Med Imaging, 2025, 26(1): 60.

[22] HUANG W, CAI X H, LI Y R, et al. The association between paraspinal muscle degeneration and osteoporotic vertebral compression fracture severity in postmenopausal women [J]. J Back Musculoskelet Rehabil, 2023, 36(2): 323-329.

[23] KAHWATI L C, KISTLER C E, BOOTH G, et al. Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task Force [J]. Jama, 2025, 333(6): 509-531.

[24] PARK C, KIM C, PARK R W, et al. Comparative effectiveness and safety outcomes between denosumab and bisphosphonate in South Korea [J]. J Bone Miner Res, 2024, 39(7): 835-43.

[25] KIM M J, PARK S Y, KANG S, et al. Low modulus PMMA-based bone cement for the reduction of adjacent vertebral fractures after vertebroplasty [J]. Acta Biomater, 2025, 203: 399-411.

[26] SENDHIL S R, CADARETTE S M, AGGARWAL S, et al. Follow-on osteoporosis therapy after denosumab discontinuation among Medicare beneficiaries [J]. Osteoporos Int, 2026, 37(1): 81-91.

[27] EVANS A R, NIZNIK T, LI C, et al. Spinal augmentation for vertebral body fractures in the elderly population [J]. Geroscience, 2025.

[28] CARLI D, VENMANS A, LODDER P, et al. Vertebroplasty versus Active Control Intervention for Chronic Osteoporotic Vertebral Compression Fractures: The VERTOS V Randomized Controlled Trial [J]. Radiology, 2023, 308(1): e222535.

[29] ZHOU C, HUANG S, LIAO Y, et al. Correlation analysis of larger side bone cement volume/vertebral body volume ratio with adjacent vertebral compression fractures during vertebroplasty [J]. Front Endocrinol (Lausanne), 2023, 14: 1072087.

[30] HE L, LI W, ZHAI X, et al. Risk factors for adjacent vertebral fracture after kyphoplasty or percutaneous vertebroplasty in osteoporotic vertebral systematic review and meta-analysis compression fractures [J]. Eur Spine J, 2025, 34(11): 5126-5141.

[31] HAIBIER A, JIE Y, YUSUFU A, et al. Effect of different cement distribution on the clinical efficacy of vertebral compression fractures in unilateral percutaneous vertebroplasty [J]. Eur Spine J, 2025, 34(5): 1673-1684.

[32] YUNTAO L, HAIBIER A, KAYIERHAN A, et al. Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the repair of osteoporotic thoracolumbar vertebral compression fractures [J]. BMC Surg, 2025, 25(1): 90.

[33] DAI C, LIANG G, ZHANG Y, et al. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis [J]. J Orthop Surg Res, 2022, 17(1): 161.

[34] XIE S, CUI L, WANG C, et al. Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically [J]. Spine J, 2025, 25(2): 324-336.

[35] ZHANG C, CAI X, LI M, et al. Preclinical Evaluation of Bioactive Small Intestinal Submucosa-PMMA Bone Cement for Vertebral Augmentation [J]. ACS Biomater Sci Eng, 2024, 10(4): 2398-2413.

[36] MIAO X, YANG S, ZHU J, et al. Bioactive mineralized small intestinal submucosa acellular matrix/PMMA bone cement for vertebral bone regeneration [J]. Regen Biomater, 2023, 10: rbad040.

[37] PARK J S, PARK Y S. Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture [J]. Spine J, 2021, 21(8): 1355-1361.

[38] LIN X B, YE H, HE L J, et al. Analysis of changes in serum high t-PINP/beta-CTX ratio and risk of re-fracture after vertebral osteoporotic fracture surgery [J]. Eur Rev Med Pharmacol Sci, 2023, 27(22): 10860-10867.

[39] YOKOYAMA K, IKEDA N, TANAKA H, et al. Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture [J]. Osteoporos Int, 2024, 35(4): 645-651.

[40] RAMESH A, KO A, PATEL P K, et al. Early Percutaneous Kyphoplasty Is Associated with Reduced Risk of Subsequent Thoracic Vertebral Compression Fracture [J]. Spine Surg Relat Res, 2026, 10(1): 105-111.

[41] HE B, ZHAO J, ZHANG M, et al. Effect of Surgical Timing on the Refracture Rate after Percutaneous Vertebroplasty: A Retrospective Analysis of at Least 4-Year Follow-Up [J]. Biomed Res Int, 2021, 2021: 5503022.

[42] WALLE M, YERITSYAN D, ABBASIAN M, et al. A graph model to describe the network connectivity of trabecular plates and rods [J]. Front Bioeng Biotechnol, 2024, 12: 1384280.

[43] WU Y, ZHU S, LI Y, et al. Analysis of Risk Factors for Augmented Vertebral Refracture After Percutaneous Kyphoplasty in Osteoporotic Vertebral Compression Fractures [J]. J Clin Med, 2025, 14(2).

[44] DAHER M, SEBAALY A, SAKR I, et al. Diagnosis and Management of Osteoporotic Vertebral Compression Fractures [J]. J Bone Joint Surg Am, 2025.