What Factors Contribute to the Poor Prognosis of Conservative Treatment for Osteoporotic Vertebral Compression Fracture (OVCF): A Systematic Review.

Background: Osteoporotic vertebral compression fracture (OVCF) is a prevalent fragility fracture in older adults, often managed with conservative treatment. However, elderly patients are particularly prone to poor prognoses under conservative management, which warrants early identification. This systematic review aims to summarize the risk factors for poor long-term prognosis in older OVCF patients receiving conservative treatment, facilitating early recognition during initial diagnosis. Methods: This systematic review followed the PRISMA statement criteria and searched the literature until June 2025. The inclusion criteria were patients with OVCFs who underwent conservative treatment only and had at least three months of follow-up. Poor prognoses include no pain relief, dysfunction, and complications such as collapse, nonunion, and kyphosis deformity. The Newcastle‒Ottawa Scale (NOS) was used to screen for articles with a low risk of bias. Results: This systematic review included 26 articles that met our inclusion criteria. These articles involved 4319 participants (80.2% female), with an average age of 72.91 years. OVCF patients with advanced age, previous spine fracture and steroid medication uses had a poor prognosis. On X-ray, poor prognoses are associated with thoracolumbar involvement, vertebral instability, middle‒column injury, initial fracture parameters, and specific fracture morphology. Additionally, specific MRI signal changes (such as diffuse low-intensity signals on T2WI, linear black sign on STIR) and fatty degeneration of the paravertebral muscle are also risk factors. Conclusion: All methods, including nonimaging, X-ray, and magnetic resonance imaging (MRI), can effectively predict the poor prognosis for OVCF patients treated conservatively. Early identification of these geriatric-specific risk factors can optimize treatment selection for elderly individuals, mitigating functional decline and improving quality of life.