Risk factors for new vertebral compression fracture following percutaneous vertebral augmentation: a systematic review and meta-analysis based on multivariate logistic regression analysis.

OBJECTIVE: This meta-analysis investigates the prevalence and risk factors for new vertebral compression fractures (NVCF) following percutaneous vertebral augmentation (PVA) in patients with osteoporotic vertebral compression fractures (OVCF). METHODS: We searched PubMed, Cochrane Library, Embase, and Web of Science (up to June 2025) and screened case-control and cohort studies that utilized multivariate logistic regression analysis to examine the prevalence and risk factors of NVCF after PVA in OVCF patients. The meta-analysis was performed according to the PRISMA guidelines. After data extraction, STATA 15.0 was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). RESULTS: This meta-analysis included 18 studies involving 7,743 patients, of whom 1,336 developed NVCF postoperatively, with a prevalence of 17.25%. The meta-analysis revealed that the risk factors for new fractures after PVA in OVCF patients were associated with Gender [OR = 1.99, 95%CI (1.50, 2.64), P < 0.001], Age [OR = 1.09, 95%CI (1.02, 1.17), P = 0.01], Bone mineral density (BMD) [OR = 0.74, 95%CI (0.63, 0.86), P < 0.001],Bone cement disc leakage [OR = 2.94, 95%CI (1.64, 5.28), P < 0.001], Lack of anti-osteoporosis treatment [OR = 2.93, 95%CI (2.14, 4.01), P < 0.001], Thoracolumbar junction (TL junction) [OR = 3.50, 95%CI (2.06, 5.93), P < 0.001], Hounsfield unit value (HU value) [OR = 0.96, 95%CI (0.95, 0.97), P < 0.001], Use of steroids [OR = 3.94, 95%CI (2.16, 7.21), P < 0.001], Number of initial fractures [OR = 2.21, 95%CI (1.17, 4.14), P = 0.01], Multiple vertebral fractures [OR = 1.71, 95%CI (1.14, 2.57), P = 0.01], Fracture history [OR = 7.72, 95%CI (3.09, 9.30), P < 0.001], Smoking [OR = 1.62, 95%CI (1.20, 2.19), P < 0.001], and Diabetes [OR = 1.98, 95%CI (1.50, 2.61), P < 0.001]. However, no association was found with Body mass index (BMI), Bone cement leakage, and Shape of bone cement. CONCLUSION: This study confirms that NVCF following PVA for OVCF is multifactorial, with most risk factors identifiable preoperatively. The clinical value of this knowledge lies in its application to guide postoperative prevention, thereby optimizing management quality through personalized follow-up and intervention.