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Summary: This nationwide multidisciplinary survey found dissatisfaction among physicians with current osteoporotic vertebral compression fracture care, revealing significant disparities in diagnosis, treatment, and follow-up practices. Issues include poor communication and differing guidelines. Improving interdisciplinary collaboration and standardized care strategies is essential for better patient outcomes. Purpose: This survey aims to assess current preferred care practices for symptomatic osteoporotic vertebral compression fractures (OVCF) in the Netherlands, focusing on guideline adherence, identifying knowledge gaps, and clarifying consensus and collaboration across medical disciplines in OVCF treatment. Methods: This cross-sectional study was conducted via Qualtrics (Provo, UT) using a self-administered online survey distributed to 238 general practitioners and physicians in orthopedics, traumatology, internal medicine, rheumatology, and geriatrics working at 51 hospitals in the Netherlands. The survey, conducted in Dutch, included 36 multiple-choice and two open questions and was accessible via an anonymous email link or QR code. General practitioners received additional questions specific to their role. Data was anonymized, stored securely, and analyzed using descriptive statistics in Microsoft Excel and SPSS (Version 24). Open-ended responses were coded and categorized. The survey was conducted prior to the publication of the updated Federation of Medical Specialists guidelines in 2024. Results: Physicians across various disciplines uniformly expressed dissatisfaction with current OVCF care. The survey highlighted significant disparities in diagnosis, treatment, and follow-up practices. A lack of communication between primary and secondary care providers and differing guidelines further complicate OVCF management. These issues point to considerable variation in clinical practice and gaps in interdisciplinary collaboration. Conclusion: Addressing the identified issues requires fostering interdisciplinary collaboration and creating cohesive care strategies. Ensuring access to diagnostic resources in both primary and secondary care and establishing coordinated care models promises more structured and standardized treatment. These steps are crucial for enhancing patient outcomes in OVCF management. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the diagnostic utility of vertebral CT value and CT value difference in distinguishing between fresh and old osteoporotic vertebral compression fractures (OVCF). Methods: A retrospective analysis was conducted on 118 patients with OVCF who underwent both MRI and CT examinations at our hospital. The nature of the fractured vertebra was determined according to MRI. The CT value of the fractured vertebrae and the mean CT value of the adjacent normal vertebrae were measured separately, and the differences between these values were calculated. Independent samples t-tests were used to compare CT value and CT value difference among all groups. The receiver operating characteristic (ROC) curve was employed to determine the optimal cut-off value for both CT value and CT value difference in differentiating fresh and old fractures. Results: The study included a total of 163 fractured vertebrae from 118 patients. The CT value of fresh fractured vertebrae was significantly higher than those of adjacent normal vertebrae, which was statistically different (P < 0.001). In contrast, the difference between CT value of old fractured vertebrae and those of adjacent normal vertebrae was not statistically significant (P > 0.05). There were significant differences in CT value and CT value difference between fresh fractured vertebrae and old fractured vertebrae (P < 0.001). The ROC curve analysis showed that the optimal cut-off value of CT value for fresh fractures and old fractures was 103.40 HU. The optimal cut-off value of CT value difference was 39.81 HU. Conclusion: Vertebral CT value and CT value difference offer a certain reference value for distinguishing between fresh and old OVCF. These parameters can serve as a rapid diagnostic tool when MRI is unavailable or impractical, aiding in the timely assessment of OVCF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies have shown that good bone cement distribution during percutaneous vertebroplasty reduces postoperative secondary vertebral fractures and helps improve prognosis. However, how to get a good distribution of bone cement is a problem for spine surgeons. OBJECTIVE: To analyze the correlation of bone cement distribution with surgical and adjacent vertebral refractures after percutaneous vertebroplasty. METHODS: A total of 193 patients with thoracolumbar compression fracture (≤ 2 fractured vertebrae) admitted to Xinjiang Uygur Autonomous Region Orthopedic Hospital from January 2018 to December 2022 were selected. They underwent percutaneous vertebroplasty via unilateral approach and were followed up after surgery. They were divided into fracture group (n=30) and non-fracture group (n=163) based on whether the surgical and adjacent vertebral fractures were observed during the follow-up period (more than 6 months). The basic data of the two groups were analyzed by univariate analysis. Statistically significant factors were replaced with binary logistic regression model to explore the correlation with recompression fracture of surgical and adjacent vertebrae after percutaneous vertebroplasty. RESULTS AND CONCLUSION: (1) Univariate analysis showed that there was no significant difference between the two groups in gender, body mass index, menopause age of female patients, bone cement dose, previous history, smoking history, drinking history, operation segment, operation time, and hospital stay (P > 0.05). There were significant differences in age, bone mineral density T value, bone cement leakage, and bone cement distribution between the two groups (P < 0.05). (2) Binary logistic regression analysis showed that age (95%CI: 1.016-1.167, P=0.016), bone cement leakage (95%CI: 0.080-0.582, P=0.002), bone mineral density T value (95%CI: 1.214-22.602, P=0.026), and bone cement distribution (P=0.007) were risk factors for recurrent fractures after percutaneous vertebroplasty and adjacent vertebroplasty. Patients with type I bone cement distribution (which did not touch the upper and lower endplates of the vertebral body) had a higher risk of recurrent fractures of surgical and adjacent vertebrae after percutaneous vertebroplasty. (3) The results of this study show that refracture of surgical and adjacent vertebrae is caused by the interaction of various risk factors. Age, bone cement leakage, T value of bone mineral density and bone cement distribution are independent risk factors for surgical and adjacent vertebral refracture. Refracture of surgical and adjacent vertebrae can easily occur when bone cement is distributed type I. [ABSTRACT FROM AUTHOR]

BACKGROUND: Percutaneous vertebroplasty has become the main treatment method for osteoporotic vertebral compression fractures due to its advantages of convenient operation and low trauma. However, the optimal bone cement-vertebral volume ratio has not been determined. OBJECTIVE: To investigate the effect of bone cement-vertebral volume ratio on percutaneous vertebroplasty for osteoporotic vertebral compression fractures. METHODS: The clinical data of 100 patients with single-stage osteoporotic vertebral compression fractures admitted to Xinjiang Bazhou People’s Hospital from July 2019 to July 2022 were retrospectively analyzed. All patients received percutaneous vertebroplasty. According to the bone cement-vertebral volume ratio, they were divided into the low volume group (15% ≤ ratio ≤ 20%) and the high volume group (20% < ratio ≤ 25%) with 50 cases in each group. The visual analog scale score, Oswestry disability index, vertebral anterior margin height, Cobb angle of injured vertebra, bone cement distribution pattern, and bone cement leakage rate were analyzed before surgery, 3 days and 1 year after surgery. RESULTS AND CONCLUSION: (1) Compared with the preoperative results, the visual analog scale scores, vertebral anterior margin height, Cobb angle of injured vertebra at 3 days and 1 year after surgery, and Oswestry disability index at 1 year after surgery were significantly improved in 100 patients (P < 0.05). There were no significant differences in visual analog scale scores at 3 days and 1 year after surgery and Oswestry disability index at 1 year after surgery between the low volume group and the high volume group (P > 0.05). The vertebral anterior margin height in the low volume group was lower than that in the high volume group at 3 days and 1 year after surgery (P < 0.05). The Cobb angle of the injured vertebrae in the low volume group was higher than that in the high volume group at 3 days and 1 year after surgery (P < 0.05). (2) There were 10 H-type and 40 O-type bone cement distributions in the low volume group. There were 36 H-type and 14 O-type bone cement distributions in the high volume group, and there was no significant difference in bone cement distributions between the two groups (P < 0.05). The bone cement leakage rate in the high volume group and low volume group was 10% and 6%, respectively. (3) It is indicated that both low and high bone cement-vertebral volume ratios can improve postoperative pain and functional dysfunction, but high bone cement-vertebral volume ratio can improve the morphological recovery of injured vertebral, which may be related to the fact that the distribution of bone cement in this group is more H-type. [ABSTRACT FROM AUTHOR]

To establish a predictive model to evaluate the risk of adjacent vertebral refracture (VRF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) based on perioperative imaging data. This study was a retrospective cohort study which established a predictive model of VRF after PKP for OVCF. Patients who underwent PKP for OVCF in our hospital between January 2018 and December 2020 were enrolled and divided into a refracture group and normal group. Perioperative imaging data including preoperative bone mineral density (BMD), fatty infiltration (FI%) of paravertebral muscle, sagittal parameters of the spine and pelvis, and recovery rate of vertebral height were collected. The prediction model is obtained by multifactor logistic regression analysis. A total of 242 patients were included, including 23 cases in the VRF group and 219 cases in the normal group. There were statistical differences in BMD, FI%, recovery rate of vertebral height, and sagittal imbalance between the 2 groups. Receiver operating characteristic curve analysis of continuous variables showed that BMD ≤−2.80, FI% ≥40%, and recovery rate of vertebral height ≥ 10% were the cutoff values. Logistic regression analysis showed that BMD ≤−2.80, FI% ≥40%, and sagittal imbalance were independent risk factors for VRF. The area under the curve according to the predicted probability was 0.85 (P < 0.05). After simplifying the model, the total point of the model was 7 points, with a cutoff value of 5 points. The prediction model obtained in this study can predict refracture after PKP for OVCF early and effectively. It has an excellent predictive effect which is suitable for clinicians. [ABSTRACT FROM AUTHOR]

Background: Adverse events of the fractured vertebra (AEFV) post-percutaneous kyphoplasty (PKP) can lead to recurrent pain and neurological damage, which considerably affect the prognosis of patients and the quality of life. This study aimed to analyze the risk factors of AEFV and develop and select the optimal risk prediction model for AEFV to provide guidance for the prevention of this condition and enhancement of clinical outcomes. Methods: This work included 383 patients with primary osteoporotic vertebral compression fracture (OVCF) who underwent PKP. The patients were grouped based on the occurrence of AEFV postsurgery, and data were collected. Group comparisons and correlation analysis were conducted to identify potential risk factors, which were then included in the five prediction models. The performance indicators served as basis for the selection of the best model. Results: Multivariate logistic regression analysis revealed the following independent risk factors for AEFV: kissing spine (odds ratio (OR) = 8.47, 95% confidence interval (CI) 1.46–49.02), high paravertebral muscle fat infiltration grade (OR = 29.19, 95% CI 4.83–176.04), vertebral body computed tomography value (OR = 0.02, 95% CI 0.003–0.13, P < 0.001), and large Cobb change (OR = 5.31, 95% CI 1.77–15.77). The support vector machine (SVM) model exhibited the best performance in the prediction of the risk of AEFV. Conclusion: Four independent risk factors were identified of AEFV, and five risk prediction models that can aid clinicians in the accurate identification of high-risk patients and prediction of the occurrence of AEFV were developed. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the clinical effect of different vertebral body heights restoration rate after percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: The patients were divided into two groups according to the height restoration rate of the anterior edge of the vertebral body fracture after PKP operation using X-Ray imaging. The group A was below 80%, and the group B was above 80%. Clinical preoperative and postoperative efficacy (1st day, 1st month, 6th month, and 12th month after surgery) were evaluated according to VAS, Oswestry Disability Index(ODI), Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO), and Back Pain Life Disorder Questionnaire(RQD). Simultaneously, the preoperative and postoperative local Cobb angles and changes in the injured vertebrae in the two groups were calculated and analyzed. Results: The postoperative Cobb angle in group A was significantly higher than that in group B. The correction rate in group B was significantly better than that in group A. The VAS, ODI, QUALEFFO, and RQD scores of group B patients were significantly lower than those of patients in group A at each follow-up time point. The correlation coefficients of vertebral body height restoration rate and VAS, ODI, QUALEFFO, and RQD scores at the last follow-up were − 0.607 (P < 0.01), -0.625 (P < 0.01), -0.696 (P < 0.01), and − 0.662 (P < 0.01), respectively. Conclusions: The results of the correlation analysis between the vertebral body height restoration rate and the above clinical efficacy scores show that increasing the vertebral body anterior height restoration rate is beneficial for pain relief and improves the clinical efficacy of patients. Simultaneously, improving the height restoration rate of the anterior edge of the vertebral body and restoring the normal spinal structure is beneficial for reducing the incidence of refracture of the adjacent vertebral body. [ABSTRACT FROM AUTHOR]

To investigate the relationship between preoperative blood glucose levels and long-term all-cause mortality in patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous vertebroplasty (VP). This single-center retrospective study involved a chart review of patients admitted for VP to treat OVCF between 2013 and 2020. Patients with pathological or multiple fractures or those who did not undergo bone mineral density assessment were excluded. All relevant information was collected from electronic medical records. The survival status of all patients was confirmed at the end of March 2021. Cox proportional hazard models with multivariate adjustments were used to examine the effects of blood glucose levels on all-cause mortality. Overall, 131 patients were retrospectively analyzed (mean age: 75.8 ± 9.3 years, male patients: 26.7%) with a median follow-up period of 2.1 years. Preoperative hyperglycemia (hazard ratio: 2.668, 95% confidence interval [CI] 1.064, 6.689; p = 0.036) and glucose levels (hazard ratio: 1.007, 95% CI 1.002–1.012; p = 0.006) were found to be independently associated with a higher risk of all-cause mortality. This correlation remained significant even after adjusting for age and sex, and other factors and comorbidities that might affect outcomes (hazard ratio: 2.708, 95% CI 1.047, 7.003, p = 0.040 and 1.007; 95% CI 1.001, 1.013, p = 0.016, respectively). Furthermore, a history of diabetes mellitus was not a significant factor influencing long-term all-cause mortality. Preoperative glucose levels were found to be independently associated with survival outcomes in patients with OVCF who underwent VP. Conversely, diabetes mellitus was not associated with long-term all-cause mortality. Our findings highlight that preoperative hyperglycemia is a risk factor for long-term mortality in this aging surgical population. [ABSTRACT FROM AUTHOR]

Balloon kyphoplasty (BKP) is an effective procedure for osteoporotic vertebral compression fractures; however, there is limited data regarding its outcomes in patients aged ≥81 years. This study investigated the treatment outcomes and prognostic factors for BKP in this age group. A retrospective analysis was conducted on 115 patients with osteoporotic vertebral compression fracture undergoing single-level BKP after failed conservative treatment, classified into the <81 years (n = 70) and ≥81 years (n = 45) groups. Surgical results were evaluated as good outcomes (independent indoors 1 year postoperatively) and poor outcomes, followed by univariate and multivariate analyses to determine prognostic factors correlating with these outcomes. The majority of patients (<81 years: 85.7%; ≥81 years: 73.3%) had a good degree of independence at 1 year postoperatively, which was comparable in both groups. Further analysis of patients aged ≥81 years showed that longer duration from onset to surgery, more subsequent vertebral fractures, and lower preoperative body mass index were correlated with poorer outcomes postoperatively, and low body mass index, time from onset to surgery, and female sex were independent risk factors for these outcomes (area under the receiver operating characteristics curve: 0.91). [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to assess the diagnostic utility of vertebral CT value and CT value difference in distinguishing between fresh and old osteoporotic vertebral compression fractures (OVCF). Methods A retrospective analysis was conducted on 118 patients with OVCF who underwent both MRI and CT examinations at our hospital. The nature of the fractured vertebra was determined according to MRI. The CT value of the fractured vertebrae and the mean CT value of the adjacent normal vertebrae were measured separately, and the differences between these values were calculated. Independent samples t-tests were used to compare CT value and CT value difference among all groups. The receiver operating characteristic (ROC) curve was employed to determine the optimal cut-off value for both CT value and CT value difference in differentiating fresh and old fractures. Results The study included a total of 163 fractured vertebrae from 118 patients. The CT value of fresh fractured vertebrae was significantly higher than those of adjacent normal vertebrae, which was statistically different (P 0.05). There were significant differences in CT value and CT value difference between fresh fractured vertebrae and old fractured vertebrae (P

Abstract Background Adverse events of the fractured vertebra (AEFV) post-percutaneous kyphoplasty (PKP) can lead to recurrent pain and neurological damage, which considerably affect the prognosis of patients and the quality of life. This study aimed to analyze the risk factors of AEFV and develop and select the optimal risk prediction model for AEFV to provide guidance for the prevention of this condition and enhancement of clinical outcomes. Methods This work included 383 patients with primary osteoporotic vertebral compression fracture (OVCF) who underwent PKP. The patients were grouped based on the occurrence of AEFV postsurgery, and data were collected. Group comparisons and correlation analysis were conducted to identify potential risk factors, which were then included in the five prediction models. The performance indicators served as basis for the selection of the best model. Results Multivariate logistic regression analysis revealed the following independent risk factors for AEFV: kissing spine (odds ratio (OR) = 8.47, 95% confidence interval (CI) 1.46–49.02), high paravertebral muscle fat infiltration grade (OR = 29.19, 95% CI 4.83–176.04), vertebral body computed tomography value (OR = 0.02, 95% CI 0.003–0.13, P

Abstract Objective This study aimed to evaluate the clinical effect of different vertebral body heights restoration rate after percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods The patients were divided into two groups according to the height restoration rate of the anterior edge of the vertebral body fracture after PKP operation using X-Ray imaging. The group A was below 80%, and the group B was above 80%. Clinical preoperative and postoperative efficacy (1st day, 1st month, 6th month, and 12th month after surgery) were evaluated according to VAS, Oswestry Disability Index(ODI), Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO), and Back Pain Life Disorder Questionnaire(RQD). Simultaneously, the preoperative and postoperative local Cobb angles and changes in the injured vertebrae in the two groups were calculated and analyzed. Results The postoperative Cobb angle in group A was significantly higher than that in group B. The correction rate in group B was significantly better than that in group A. The VAS, ODI, QUALEFFO, and RQD scores of group B patients were significantly lower than those of patients in group A at each follow-up time point. The correlation coefficients of vertebral body height restoration rate and VAS, ODI, QUALEFFO, and RQD scores at the last follow-up were − 0.607 (P

BACKGROUND: There have been many studies on adjacent vertebral fractures in elderly female patients with osteoporotic vertebral compression fractures, but their related risk factors are still in debate. There are also few studies on how to intuitively present their risks for clinical application. OBJECTIVE: To analyze the risk factors of adjacent vertebral refracture in senile women with osteoporotic vertebral compression fracture and construct a Nomogram prediction model. METHODS: A total of 268 elderly female patients with osteoporotic vertebral compression fracture who came to Ganzhou People’s Hospital for treatment from January 2018 to November 2022 were selected and divided into study group (adjacent vertebral refracture, n=31) and control group (no adjacent vertebral refracture, n=237) according to whether adjacent vertebral refracture occurred 3 months after percutaneous vertebroplasty. General clinical data were compared between the two groups. Multivariate Logistic regression analysis was conducted to analyze the independent risk factors of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. A Nomogram prediction model was constructed by R software “rms” package. RESULTS AND CONCLUSION: (1) There were statistically significant differences in age, menopause age, body mass index, fracture history, number of fractured vertebra before surgery, bone cement leakage, bone density, postoperative kyphotic deformity angle, and preoperative Oswestry disability index between the two groups (P < 0.05). (2) Multivariate logistic regression analysis results showed that age (> 69 years old), menopause age (≤ 51 years old), body mass index (> 24.7 kg/m² ), fracture history (presence), number of fractured vertebra before surgery (≥ 2), and postoperative kyphotic deformity angle (> 13°) were independent risk factors for adjacent vertebral refracture in elderly female osteoporotic vertebral compression fracture patients (P < 0.05). (3) Nomogram prediction model decision curve results displayed that when the risk threshold was > 0.09, this prediction model provided significant additional clinical net benefit. (4) These findings indicate that older age, lower menopause age, higher body mass index, history of fracture, more vertebra fractures before surgery, and larger kyphosis angle after surgery are independent factors for adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. This Nomogram prediction model will provide important strategic guidance for the prevention and treatment of adjacent vertebral refracture in elderly women with osteoporotic vertebral compression fracture. [ABSTRACT FROM AUTHOR]

Vertebral compression fracture is a common disease in the current orthopedic field. However, the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored, which has a serious impact on the normal life of patients. OBJECTIVE: The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images. By using finite element analysis, we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS: A finite element model of the thoracolumbar spine (T11-L3) was established and validated, on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%, 80%, 60%, and 40% were constructed, in which the cement capacity varied with the recovery height. The specific models are as follows: Model 1 was the postoperative model with normal recovery height, and the cement capacity was 8.3 mL. Model 2 was the postoperative model in which 20% of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°, and the cement capacity was 6.9 mL. Model 3 was the postoperative model in which 40% of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°, and the cement capacity was 4.7 mL. Model 4 was a postoperative model with 60% of the L1 anterior height removed and the posterior convexity angle changed to 28.85°, with a cement capacity of 3.6 mL. For evaluation of the postoperative model, we applied a moment of 7 Nm and an axial force of 500 N. The followings were recorded and analyzed: peak stresses in the L2 upper endplate and T12 lower endplate; peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION: (1) The highest peak stresses for each condition of the L2 upper endplate, T12 lower endplate, L2 cancellous bone, and T12 cancellous bone occurred in Model 1 and Model 4. In particular, the T12 lower endplate, except for the posterior extension condition, the anterior flexion, left and right lateral bending, and left and right rotation conditions all reached their highest peak stresses in Model 4, with stresses of 50.3, 33.1, 44.9, 34.3, and 31.9 MPa. (2) Based on the peak stresses in the adjacent vertebral endplates and cancellous bone, after excluding Model 1 and Model 4, the minimum peak stresses for most of the conditions appeared in the Model 2, and the minimum peak stresses appeared in the Model 2 in 66.6% of the cases, especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition, the minimum peak stresses all appeared on the Model 2. (3) Therefore, controlling the recovery height at about 100% and 40% of the original height was a dangerous recovery height, which had a greater impact on the neighboring vertebrae. Controlling the recovery height at about 80% of the original height may be a more ideal choice. With a recovery height of about 80% of the original height, the adjacent vertebrae are subjected to less stress, thus reducing the risk of re-fracture of the adjacent vertebrae in the patient. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bibliometrics and visual analyses based on thematic literature are particularly important for understanding the foundation and frontiers of postmenopausal osteoporosis research. OBJECTIVE: To perform bibliometric, citation, and visualization analyses of highly cited SCI papers in postmenopausal osteoporosis research over the last 20 years. METHODS: The top 100 highly cited papers on postmenopausal osteoporosis published between 2003 and 2022 included in SCI-EXPANDED catalog of the Web of Science database were obtained for bibliometric measure and visual analysis using CiteSpace software. RESULTS AND CONCLUSION: The top 100 highly cited papers have a total of 67 377 citations in the Web of Science Core Collection, with an annual average of 49.17 citations per paper. Postmenopausal osteoporosis research primarily involves medical, engineering, biological, and multidisciplinary fields. The subcategories are dominated by endocrinology and metabolism, and medicine: internal medicine. Stable and close cooperative network relationships have been formed globally. United States, University of California System, Cummings, and Steven R are the country, research institution, and author, respectively, with the most highly-cited publications. The frontiers of postmenopausal osteoporosis research mainly include calcium and vitamin D supplementation and fracture risk, clinical studies of bisphosphonates in the treatment of postmenopausal osteoporosis, atypical femur fracture, clinical studies of new drugs and sequential treatment of postmenopausal osteoporosis, predictors of fracture risk, mid- and long-term follow-up of osteoporotic vertebral compression fractures, genetic polymorphisms and hereditary factors, formulation and updating of clinical practice guidelines for postmenopausal osteoporosis. Large cohort studies, high-quality randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines are the great engines that drive the development of clinical research in postmenopausal osteoporosis. We should make efforts in the above areas to improve China’s international influence in the field of osteoporosis. [ABSTRACT FROM AUTHOR]

Abstract To investigate the relationship between preoperative blood glucose levels and long-term all-cause mortality in patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous vertebroplasty (VP). This single-center retrospective study involved a chart review of patients admitted for VP to treat OVCF between 2013 and 2020. Patients with pathological or multiple fractures or those who did not undergo bone mineral density assessment were excluded. All relevant information was collected from electronic medical records. The survival status of all patients was confirmed at the end of March 2021. Cox proportional hazard models with multivariate adjustments were used to examine the effects of blood glucose levels on all-cause mortality. Overall, 131 patients were retrospectively analyzed (mean age: 75.8 ± 9.3 years, male patients: 26.7%) with a median follow-up period of 2.1 years. Preoperative hyperglycemia (hazard ratio: 2.668, 95% confidence interval [CI] 1.064, 6.689; p = 0.036) and glucose levels (hazard ratio: 1.007, 95% CI 1.002–1.012; p = 0.006) were found to be independently associated with a higher risk of all-cause mortality. This correlation remained significant even after adjusting for age and sex, and other factors and comorbidities that might affect outcomes (hazard ratio: 2.708, 95% CI 1.047, 7.003, p = 0.040 and 1.007; 95% CI 1.001, 1.013, p = 0.016, respectively). Furthermore, a history of diabetes mellitus was not a significant factor influencing long-term all-cause mortality. Preoperative glucose levels were found to be independently associated with survival outcomes in patients with OVCF who underwent VP. Conversely, diabetes mellitus was not associated with long-term all-cause mortality. Our findings highlight that preoperative hyperglycemia is a risk factor for long-term mortality in this aging surgical population.

Abstract Objective This study analyzes the safety and efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) treatments for Stage III Kummell’s disease without neurological symptoms, comparing the advantages and disadvantages of these two minimally invasive surgical methods. Methods A retrospective analysis was conducted on 53 patients with non-neurological Stage III Kummell’s disease treated with PVP and PKP at our hospital from December 2018 to January 2023. Patients were divided into PVP (25 cases) and PKP (28 cases) groups based on the surgical method. There were no significant differences in general preoperative data between the two groups (all p > 0.05), ensuring comparability. The study compared surgical duration, volume of bone cement injected, distribution pattern of bone cement, rate of bone cement leakage, and preoperative, postoperative, and final follow-up scores of Visual analogue scale(VAS) and Oswestry disability index(ODI). Additionally, relative anterior height of the injured vertebrae, and Cobb angle of deformity, along with their changes at preoperative, postoperative, and final follow-up stages were calculated and analyzed. Results No significant preoperative differences were observed between the groups (p > 0.05). The PKP group had longer surgeries, higher cement volumes (p 0.05) but improved significantly from preoperative (p 0.05). Conclusion The study evaluates the safety and efficacy of PVP and PKP for Stage III Kummell’s disease without neurological symptoms, comparing the merits of both minimally invasive techniques.

Abstract Adjacent vertebral fracture (AVF) is a serious complication of percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). This study aimed to explore the incidence and risk factors of AVF following PVP or PKP in postmenopausal women. The incidence of AVF was determined by spinal radiographic examinations. The potential risk factors of AVF were identified by univariate analysis, followed by multivariate logistic regression analyses to determine the independent risk factors. In total, 674 postmenopausal women who were treated with PVP or PKP from December 2019 to February 2022 were enrolled in the study. Among them, 58 (8.61%) women experienced an AVF following PVP or PKP. After adjusting for confounding factors, BMI (OR [95% CI] 0.863 [0.781–0.952]; p = 0.003), previous history of OVCF (OR [95% CI] 1.931 [1.044–3.571]; p = 0.036), and Hounsfield unit (HU) value (OR [95% CI] 0.979 [0.967–0.990]; p

Abstract Background Osteoporosis vertebral compression fracture (OVCF) secondary to osteoporosis is a common health problem in the elderly population. Vertebral augmentation (VA) has been widely used as a minimally invasive surgical method. The transpedicle approach is commonly used for VA puncture, but sometimes, it is limited by the anatomy of the vertebral body and can not achieve good surgical results. Therefore, we propose the treatment of OVCF with precise puncture vertebral augmentation (PPVA). This study used finite element analysis to explore the biomechanical properties of PPVA in the treatment of osteoporotic vertebral compression fractures (OVCFs) with wedge, biconcave, and collapse deformities. Method Three-dimensional finite element models of the fractured vertebral body and adjacent superior and inferior vertebral bodies were established using Computed Tomography (CT) data from patients with OVCF, both before and after surgery. Evaluate the stress changes of the wedged deformed vertebral body, biconcave deformed vertebral body, collapsed deformed vertebral body, and adjacent vertebral bodies before and after PPVA. Result In vertebral bodies with wedge deformity and collapsed deformity, PPVA can effectively reduce the stress on the vertebral body but increases the stress on the vertebral body with biconcave deformity. PPVA significantly decreases the stress on the adjacent vertebral bodies of the wedge deformed vertebral body, and decreases the stress on the adjacent superior vertebral body of biconcave deformity and collapsed deformed vertebral bodies, but increases the stress on the adjacent inferior vertebral bodies. PPVA improves the stress distribution of the vertebral body and prevents high-stress areas from being concentrated on one side of the vertebral body. Conclusion PPVA has shown positive surgical outcomes in treating wedge deformed and collapsed deformed vertebral bodies. However, its effectiveness in treating biconcave vertebral body is limited. Furthermore, PPVA has demonstrated favorable results in addressing adjacent superior vertebral body in three types of fractures.

PURPOSE: This study aimed to explore the relationship between the time from percutaneous vertebral augmentation (PVA) until subsequent fracture and the risk of new symptomatic fractures (NSFs) in untreated vertebrae at different distances from “augmented vertebrae”. METHODS: Patients who underwent PVA for the treatment of osteoporotic vertebral compression fractures at the West China Hospital of Sichuan University from May 2014 to April 2019 were retrospectively recruited. Vertebrae not treated during PVA were stratified based on their distance from the nearest augmented vertebra and the time elapsed since PVA. Survival curves were plotted to compare the risk of NSFs in untreated vertebrae at different distances from augmented vertebrae. The Cox proportional hazards model was used to identify risk factors of NSFs in untreated vertebrae. RESULTS: total, 162 patients with 228 NSFs (2.760 vertebrae) were analyzed. More than half of the NSFs (56.6%) occurred within the first year after PVA. Rates and hazard ratios (HRs) of NSFs were higher in vertebrae located one segment away from the augmented vertebrae (21.0%, HR: 3.99, P < 0.001), two segments away (10.6%, HR: 1.97, P = 0.003), or three segments away (10.5%, HR: 2.26, P < 0.001) than in vertebrae located five or more segments away (3.81%, HR: 1.00). Similar results were observed regardless of whether the untreated vertebrae were located in the thoracolumbar junction. In addition to distance, other risk factors of NSFs were the thoracolumbar location of untreated vertebrae, the number of augmented vertebrae, and percutaneous vertebroplasty. CONCLUSION: The risk of NSFs is greater for untreated vertebrae located closer to augmented vertebrae than for untreated vertebrae further away. This distance dependence occurs mainly within the three segments closest to the augmented vertebra. The risk of NSFs decreases with time after augmentation, and it is also related to the number of augmented vertebrae, the type of augmentation, and whether the untreated vertebrae are thoracolumbar or not.

Abstract Purpose To evaluate the value of five indicators in predicting OVCF through a retrospective case–control study, and explore the internal correlation of different indicators. Method We retrospectively enrolled patients over 50 years of age who had been subjected to surgery for fragility OVCF at China Japan Friendship Hospital from January 2021 to September 2023. Demographic characteristics, T-score based on dual-energy X-ray absorptiometry (DXA), CT-based Hounsfield unit (HU) value, vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI), relative cross-sectional area (rCSA) and the rate of fat infiltration (FI) of paraspinal muscle were collected. A 1:1 age- and sex-matched, fracture-free control group was established from patients admitted to our hospital for lumbar spinal stenosis or lumbar disk herniation. Results A total of 78 patients with lumbar fragility OVCF were included. All the five indicators were significantly correlated with the occurrence of OVCFs. Logistic regression analysis showed that average HU value and VBQ score were significantly correlated with OVCF. The area under the curve (AUC) of VBQ score was the largest (0.89). There was a significantly positive correlation between average T-score, average HU value and average total rCSA. VBQ score was significantly positive correlated with FI. Conclusion VBQ score and HU value has good value in predicting of fragility OVCF. In addition to bone mineral density, we should pay more attention to bone quality, including the fatty signal intensity in bone and the FI in paraspinal muscle.

Adjacent vertebral fracture (AVF) is a serious complication of percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). This study aimed to explore the incidence and risk factors of AVF following PVP or PKP in postmenopausal women. The incidence of AVF was determined by spinal radiographic examinations. The potential risk factors of AVF were identified by univariate analysis, followed by multivariate logistic regression analyses to determine the independent risk factors. In total, 674 postmenopausal women who were treated with PVP or PKP from December 2019 to February 2022 were enrolled in the study. Among them, 58 (8.61%) women experienced an AVF following PVP or PKP. After adjusting for confounding factors, BMI (OR [95% CI] 0.863 [0.781–0.952]; p = 0.003), previous history of OVCF (OR [95% CI] 1.931 [1.044–3.571]; p = 0.036), and Hounsfield unit (HU) value (OR [95% CI] 0.979 [0.967–0.990]; p < 0.001) were found to be independent risk factors of AVF following PVP or PKP in postmenopausal women. The ROC analysis revealed that the BMI and HU thresholds were 21.43 and 65.15, respectively. In conclusion, the incidence of AVF was 8.61%. BMI, previous history of OVCF and HU value were independent risk factors of AVF following PVP or PKP in postmenopausal women. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral compression fractures (OVCFs) are the most prevalent fractures among patients with osteoporosis, leading to severe pain, deformities, and even death. This study explored the use of ectopic embryonic calvaria derived mesenchymal stem cells (EE-cMSCs), which are known for their superior differentiation and proliferation capabilities, as a potential treatment for bone regeneration in OVCFs. We evaluated the impact of EE-cMSCs on osteoclastogenesis in a RAW264.7 cell environment, which was induced by the receptor activator of nuclear factor kappa-beta ligand (RANKL), using cytochemical staining and quantitative real-time PCR. The osteogenic potential of EE-cMSCs was evaluated under various hydrogel conditions. An osteoporotic vertebral body bone defect model was established by inducing osteoporosis in rats through bilateral ovariectomy and creating defects in their coccygeal vertebral bodies. The effects of EE-cMSCs were examined using micro-computed tomography (μCT) and histology, including immunohistochemical analyses. In vitro, EE-cMSCs inhibited osteoclast differentiation and promoted osteogenesis in a 3D cell culture environment using fibrin hydrogel. Moreover, μCT and histological staining demonstrated increased new bone formation in the group treated with EE-cMSCs and fibrin. Immunostaining showed reduced osteoclast activity and bone resorption, alongside increased angiogenesis. Thus, EE-cMSCs can effectively promote bone regeneration and may represent a promising therapeutic approach for treating OVCFs. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of vertebroplasty through different pedicle approaches in the treatment of osteoporotic vertebral compression fracture osteoporotic vertebral compression fractures (OVCF) by network meta-analysis. Methods: Pubmed, Embase, Cochrane Library, Web of Science. Database for literature retrieval, retrieval time from the establishment of the database to April 2023, the randomized controlled trials of unilateral vertebroplasty (UVP), bilateral vertebroplasty (BVP), unilateral kyphoplasty (UKP), bilateral kyphoplasty (BKP), curved vertebroplasty (CVP) and curved kyphoplasty (CKP) were screened, evaluated and the data were extracted and included in the analysis. STATA 15.0 and ReMan 5.3 were used for data analysis. This study was registered in the National Institute for Health Research (NIHR) with the registration number CRD42023405181. Results: This study included 16 articles with a total of 1712 patients. The order of visual analogue scale (VAS) improvement from good to bad is CVP > BVP > UVP > CKP > BKP > UKP. The order of kyphotic angles improvement from good to bad is CKP > UKP > UKP > UVP > BVP > CVP. The order of bone cement injection from less to more is UVP > CVP > UKP > CKP > BVP > BKP. The order of bone cement leakage rate from less to more is CKP > CVP > UKP > BKP > UVP > BVP. The order of X-ray exposure time from less to more is CKP > CVP > UVP > BVP > UKP > BKP. The order of operation time from less to more is CVP > UVP > UKP > CKP > BVP > BKP. Conclusion: For patients with kyphotic angles, kyphoplasty has unique advantages in improving kyphotic angles. But generally speaking, curved approach can optimize the distribution of bone cement through unilateral approach to achieve the orthopedic effect of bilateral approach, which is a minimally invasive technique with better curative effect and higher safety in the treatment of OVCF. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis vertebral compression fracture (OVCF) secondary to osteoporosis is a common health problem in the elderly population. Vertebral augmentation (VA) has been widely used as a minimally invasive surgical method. The transpedicle approach is commonly used for VA puncture, but sometimes, it is limited by the anatomy of the vertebral body and can not achieve good surgical results. Therefore, we propose the treatment of OVCF with precise puncture vertebral augmentation (PPVA). This study used finite element analysis to explore the biomechanical properties of PPVA in the treatment of osteoporotic vertebral compression fractures (OVCFs) with wedge, biconcave, and collapse deformities. Method: Three-dimensional finite element models of the fractured vertebral body and adjacent superior and inferior vertebral bodies were established using Computed Tomography (CT) data from patients with OVCF, both before and after surgery. Evaluate the stress changes of the wedged deformed vertebral body, biconcave deformed vertebral body, collapsed deformed vertebral body, and adjacent vertebral bodies before and after PPVA. Result: In vertebral bodies with wedge deformity and collapsed deformity, PPVA can effectively reduce the stress on the vertebral body but increases the stress on the vertebral body with biconcave deformity. PPVA significantly decreases the stress on the adjacent vertebral bodies of the wedge deformed vertebral body, and decreases the stress on the adjacent superior vertebral body of biconcave deformity and collapsed deformed vertebral bodies, but increases the stress on the adjacent inferior vertebral bodies. PPVA improves the stress distribution of the vertebral body and prevents high-stress areas from being concentrated on one side of the vertebral body. Conclusion: PPVA has shown positive surgical outcomes in treating wedge deformed and collapsed deformed vertebral bodies. However, its effectiveness in treating biconcave vertebral body is limited. Furthermore, PPVA has demonstrated favorable results in addressing adjacent superior vertebral body in three types of fractures. [ABSTRACT FROM AUTHOR]

To investigate whether risk of new vertebral compression fractures (NVCFs) was associated with vicinity to treated vertebrae in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). All OVCF (T6-L5) patients treated with PVP between January 2016 and December 2020 were retrospectively reviewed. Vicinity to treated vertebrae was defined as the number of vertebrae between an untreated and its closest treated level. The closest treated level was chosen as reference vertebra. Clinical, radiologic, and surgical parameters were compared between groups of reference vertebrae for each vicinity NVCF. In total, 1348 patients with 1592 fractured and 14,584 normal vertebrae were enrolled. NVCF was identified in 20.1% (271 of 1348) patients in 2.2% (319 of 14584) vertebrae in a mean follow-up time of 24.3 ± 11.9 months. Rate of NVCF in vicinity 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11 level were 4.6% (130 of 2808), 2.4% (62 of 2558), 1.8% (42 of 2365), 1.5% (31 of 2131), 1.3% (23 of 1739), 1.3% (17 of 1298), 0.8% (7 of 847), 0.9% (4 of 450), 0.8% (2 of 245), 0.9% (1 of 117), and 0% (0 of 26), respectively. Rate of NVCF in vicinity 1 level was significantly higher than that in vicinity 2, 3, 4, 5, 6, 7, 8, and 9 level, respectively. However, compared to reference vertebrae for vicinity 1 NVCF, any clinical, radiologic, or surgical parameters were not significantly different in those for vicinity 2, 3, and 4 NVCF, respectively. The closer vicinity to treated vertebrae in PVP, the higher rate of NVCF at follow-up. However, any clinical, radiologic, or surgical parameters might not matter in this phenomenon of vicinity-related NVCF. [ABSTRACT FROM AUTHOR]

PURPOSE This study aimed to explore the relationship between the time from percutaneous vertebral augmentation (PVA) until subsequent fracture and the risk of new symptomatic fractures (NSFs) in untreated vertebrae at different distances from "augmented vertebrae". METHODS Patients who underwent PVA for the treatment of osteoporotic vertebral compression fractures at the West China Hospital of Sichuan University from May 2014 to April 2019 were retrospectively recruited. Vertebrae not treated during PVA were stratified based on their distance from the nearest augmented vertebra and the time elapsed since PVA. Survival curves were plotted to compare the risk of NSFs in untreated vertebrae at different distances from augmented vertebrae. The Cox proportional hazards model was used to identify risk factors of NSFs in untreated vertebrae. RESULTS In total, 162 patients with 228 NSFs (2.760 vertebrae) were analyzed. More than half of the NSFs (56.6%) occurred within the first year after PVA. Rates and hazard ratios (HRs) of NSFs were higher in vertebrae located one segment away from the augmented vertebrae (21.0%, HR: 3.99, P < 0.001), two segments away (10.6%, HR: 1.97, P = 0.003), or three segments away (10.5%, HR: 2.26, P < 0.001) than in vertebrae located five or more segments away (3.81%, HR: 1.00). Similar results were observed regardless of whether the untreated vertebrae were located in the thoracolumbar junction. In addition to distance, other risk factors of NSFs were the thoracolumbar location of untreated vertebrae, the number of augmented vertebrae, and percutaneous vertebroplasty. CONCLUSION The risk of NSFs is greater for untreated vertebrae located closer to augmented vertebrae than for untreated vertebrae further away. This distance dependence occurs mainly within the three segments closest to the augmented vertebra. The risk of NSFs decreases with time after augmentation, and it is also related to the number of augmented vertebrae, the type of augmentation, and whether the untreated vertebrae are thoracolumbar or not. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the value of five indicators in predicting OVCF through a retrospective case–control study, and explore the internal correlation of different indicators. Method: We retrospectively enrolled patients over 50 years of age who had been subjected to surgery for fragility OVCF at China Japan Friendship Hospital from January 2021 to September 2023. Demographic characteristics, T-score based on dual-energy X-ray absorptiometry (DXA), CT-based Hounsfield unit (HU) value, vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI), relative cross-sectional area (rCSA) and the rate of fat infiltration (FI) of paraspinal muscle were collected. A 1:1 age- and sex-matched, fracture-free control group was established from patients admitted to our hospital for lumbar spinal stenosis or lumbar disk herniation. Results: A total of 78 patients with lumbar fragility OVCF were included. All the five indicators were significantly correlated with the occurrence of OVCFs. Logistic regression analysis showed that average HU value and VBQ score were significantly correlated with OVCF. The area under the curve (AUC) of VBQ score was the largest (0.89). There was a significantly positive correlation between average T-score, average HU value and average total rCSA. VBQ score was significantly positive correlated with FI. Conclusion: VBQ score and HU value has good value in predicting of fragility OVCF. In addition to bone mineral density, we should pay more attention to bone quality, including the fatty signal intensity in bone and the FI in paraspinal muscle. [ABSTRACT FROM AUTHOR]

BackgroundBone cement leakage (BCL) is one of the most prevalent complications of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF), which may result in severe secondary complications and poor outcomes. Previous studies employed several traditional machine learning (ML) models to predict BCL preoperatively, but effective and intelligent methods to bridge the distance between current models and real-life clinical applications remain lacking.MethodsWe will develop a deep learning (DL)-based prediction model that directly analyzes preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of patients with OVCF to accurately predict BCL occurrence and classification during PKP. This retrospective study includes a retrospective internal dataset for DL model training and validation, a prospective internal dataset, and a cross-center external dataset for model testing. We will evaluate not only model’s predictive performance, but also its reliability by calculating its consistency with reference standards and comparing it with that of clinician prediction.DiscussionThe model holds an imperative clinical significance. Clinicians can formulate more targeted treatment strategies to minimize the incidence of BCL, thereby improving clinical outcomes by preoperatively identifying patients at high risk for each BCL subtype. In particular, the model holds great potential to be extended and applied in remote areas where medical resources are relatively scarce so that more patients can benefit from quality perioperative evaluation and management strategies. Moreover, the model will efficiently promote information sharing and decision-making between clinicians and patients, thereby increasing the overall quality of healthcare services.

Abstract Purpose To analyze the association between scoliosis and vertebral refracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs). Methods A retrospective study was conducted on 269 patients meeting the criteria from January 2014 to October 2022. All patients underwent PKP with complete data and were followed-up for > 12 months. First, it was verified that scoliosis was a risk factor in 269 patients. Second, patients with scoliosis were grouped based on the Cobb angle to evaluate the impact of the post-operative angle. The cox proportional hazards regression analysis and survival analysis were used to calculate the hazard ratio and recurrence time. Results A total of 56 patients had scoliosis, 18 of whom experienced refractures after PKP. The risk factors for vertebral refractures included a T-score

Abstract Purpose The aim of this study was to develop and validate a machine learning (ML) model for predicting the risk of new osteoporotic vertebral compression fracture (OVCF) in patients who underwent percutaneous vertebroplasty (PVP) and to create a user-friendly web-based calculator for clinical use. Methods A retrospective analysis of patients undergoing percutaneous vertebroplasty: A retrospective analysis of patients treated with PVP between June 2016 and June 2018 at Liuzhou People's Hospital was performed. The independent variables of the model were screened using Boruta and modelled using 9 algorithms. Model performance was assessed using the area under the receiver operating characteristic curve (ROC_AUC), and clinical utility was assessed by clinical decision curve analysis (DCA). The best models were analysed for interpretability using SHapley Additive exPlanations (SHAP) and the models were deployed visually using a web calculator. Results Training and test groups were split using time. The SVM model performed best in both the training group tenfold cross-validation (CV) and validation group AUC, with an AUC of 0.77. DCA showed that the model was beneficial to patients in both the training and test sets. A network calculator developed based on the SHAP-based SVM model can be used for clinical risk assessment ( https://nicolazhang.shinyapps.io/refracture_shap/ ). Conclusions The SVM-based ML model was effective in predicting the risk of new-onset OVCF after PVP, and the network calculator provides a practical tool for clinical decision-making. This study contributes to personalised care in spinal surgery.

Abstract Background Early assessment of the risk of nonunion in osteoporotic vertebral compression fracture (OVCF) is beneficial to early clinical decision making. However, a comprehensive understanding of the risk factors for OVCF nonunion is lacking. Methods We conducted a case–control study to investigate risk factors for OVCF nonunion. Patients who underwent surgery for nonunited OVCFs between January 2011 and December 2021 were eligible for inclusion as cases. Patients with successful OVCF healing confirmed by MRI over the same period were identified as controls. Patient demographics, comorbidities, and fasting blood test data were extracted for analysis. Results A total of 201 patients with nonunited OVCFs and 1044 controls were included to evaluate the risk factors for nonunited OVCFs. There were statistically significant differences in sex, age, number of patients with hypertension, number of patients on bed rest after OVCF and T-score of BMD between the two groups. Logistic regression showed that female patients had a higher risk of OVCF nonunion than male patients and that smoking, drinking, diabetes, and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. We also found that age, BMD, FBG, and β-CTX were positively correlated with nonunited OVCFs, and that HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Conclusion Smoking, drinking, diabetes and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. Age, BMD, FBG and β-CTX were positively correlated with nonunited OVCFs, while HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Based on the results of our study, we suggest that bed rest or spinal support for at least 3 consecutive weeks is necessary to reduce the risk of OVCFs nonunion.

Objective: To explore the appropriate bone cement filling ratio in percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: Clinical and radiological data from 150 OVCF patients treated with PKP were retrospectively analyzed. Patients were categorized into three groups based on bone cement filling ratio: low (<0.4), medium (0.4-0.6), and high (>0.6) filling ratio groups. The clinical characteristics (age, gender, BMI, etc.) and related study data (bone cement leakage and its location, pre/post-operative Visual Analogue Scale (VAS), pre/post-operative Oswestry Disability Index (ODI), vertebral height restoration, kyphotic Cobb angle, etc.) among the three groups were compared using statistical software to compare to identify the most appropriate cement filling ratio. Results: The 0.4-0.6 group presented a lower cement leakage rate compared to the >0.6 group, and there were no significant differences in pre-operative VAS, post-operative day 2 VAS, post-operative month 1 VAS, and pre-operative ODI (p>0.05). However, significant differences were observed in post-operative month 3 VAS (p=0.002), post-operative day 2 ODI (p=0.002), post-operative month 1 ODI (p<0.001), and post-operative month 3 ODI (p<0.001). The "0.4-0.6" group showed better pain improvement and functional recovery compared with the ">0.6" group at the 3-month follow-up. While presenting the best vertebral height restoration, the ">0.6" group also exhibited the greatest variability. Additionally, no significant difference in Cobb angle changes was observed among the groups. Conclusion: A bone cement filling ratio of 0.4-0.6 in PKP treatment for OVCF strikes a favorable balance between complication reduction and positive patient outcomes, warranting it as an optimal filling volume. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the association between scoliosis and vertebral refracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs). Methods: A retrospective study was conducted on 269 patients meeting the criteria from January 2014 to October 2022. All patients underwent PKP with complete data and were followed-up for > 12 months. First, it was verified that scoliosis was a risk factor in 269 patients. Second, patients with scoliosis were grouped based on the Cobb angle to evaluate the impact of the post-operative angle. The cox proportional hazards regression analysis and survival analysis were used to calculate the hazard ratio and recurrence time. Results: A total of 56 patients had scoliosis, 18 of whom experienced refractures after PKP. The risk factors for vertebral refractures included a T-score < − 3.0 and presence of scoliosis (both p < 0.001). The results indicated that the vertebral fractured arc (T10 − L4) was highly influential in scoliosis and vertebral fractures. When scoliotic and initially fractured vertebrae were situated within T10 − L4, the risk factors for vertebral refracture included a postoperative Cobb angle of ≥ 20° (p = 0.002) and an increased angle (p = 0.001). The mean recurrence times were 17.2 (10.7 − 23.7) months and 17.6 (7.9 − 27.3) months, respectively. Conclusion: Osteoporosis combined with scoliosis significantly increases the risk of vertebral refractures after PKP in patients with OVCFs. A postoperative Cobb angle of ≥ 20° and an increased angle are significant risk factors for vertebral refractures when scoliotic and initially fractured vertebrae are situated within T10 − L4. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to develop and validate a machine learning (ML) model for predicting the risk of new osteoporotic vertebral compression fracture (OVCF) in patients who underwent percutaneous vertebroplasty (PVP) and to create a user-friendly web-based calculator for clinical use. Methods: A retrospective analysis of patients undergoing percutaneous vertebroplasty: A retrospective analysis of patients treated with PVP between June 2016 and June 2018 at Liuzhou People's Hospital was performed. The independent variables of the model were screened using Boruta and modelled using 9 algorithms. Model performance was assessed using the area under the receiver operating characteristic curve (ROC_AUC), and clinical utility was assessed by clinical decision curve analysis (DCA). The best models were analysed for interpretability using SHapley Additive exPlanations (SHAP) and the models were deployed visually using a web calculator. Results: Training and test groups were split using time. The SVM model performed best in both the training group tenfold cross-validation (CV) and validation group AUC, with an AUC of 0.77. DCA showed that the model was beneficial to patients in both the training and test sets. A network calculator developed based on the SHAP-based SVM model can be used for clinical risk assessment (https://nicolazhang.shinyapps.io/refracture%5fshap/). Conclusions: The SVM-based ML model was effective in predicting the risk of new-onset OVCF after PVP, and the network calculator provides a practical tool for clinical decision-making. This study contributes to personalised care in spinal surgery. [ABSTRACT FROM AUTHOR]

To establish a porcine osteoporotic vertebral compression fracture model and compare the impact of unilateral vertebroplasty using trajectory-adjustable bone cement filling device to traditional surgical tools on vertebral biomechanics. Twenty-four fresh adult porcine vertebrae were used to establish an osteoporotic vertebral compression fracture model. The specimens were divided into 4 groups (A, B, C, and D), each consisting of 6 vertebrae. Group A served as the control group without vertebral augmentation (percutaneous vertebroplasty [PVP]). Patients in Group B underwent unilateral PVP using conventional surgical tools, while patients in Group C underwent bilateral PVP using the same tools. In Group D, patients underwent unilateral PVP with a trajectory-adjustable bone cement filling device. Postoperative X-ray examinations were performed to assess cement distribution and leakage. The compressive stiffness and strength of each spinal unit were evaluated using an electronic mechanical testing machine. In Groups B, C, and D, the percentages of total cement distribution area were 32.83 ± 3.64%, 45.73 ± 2.27%, and 47.43 ± 3.51%, respectively. The values were significantly greater in Groups C and D than in Group B (P < 0.05), but there was no significant difference between Groups C and D (P > 0.05). The stiffness after vertebral augmentation in Groups B, C, and D was 1.04 ± 0.23 kN/mm, 1.11 ± 0.16 KN/mm, and 1.15 ± 0.13 KN/mm, respectively, which were significantly greater than that in Group A (0.46 ± 0.06 kN/mm; P < 0.05). The ultimate compressive strengths in Groups B, C, and D were 2.53 ± 0.21 MPa, 4.09 ± 0.30 MPa, and 3.99 ± 0.29 MPa, respectively, all surpassing Group A's strength of 1.41 ± 0.31 MPa. Additionally, both Groups C and D demonstrated significantly greater ultimate compressive strengths than Group B did (P < 0.05). A trajectory-adjustable bone cement filling device was proven to be an effective approach for unilateral vertebroplasty, restoring the biomechanical properties of fractured vertebrae. Compared to traditional surgical tools, this approach is superior to unilateral puncture and yields outcomes comparable to those of bilateral puncture. Additionally, the device ensures a centrally symmetrical distribution pattern of bone cement, leading to improved morphology. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional interventions such as vertebroplasty and kyphoplasty, despite their widespread use, are limited in addressing the secondary effects of vertebral fractures in adjacent areas and do not facilitate bone regeneration. This review paper explores the emerging domain of regenerative therapies, spotlighting stem cell therapy's transformative potential in OVCF treatment. It thoroughly describes the therapeutic possibilities and mechanisms of action of mesenchymal stem cells against OVCFs, relying on recent clinical trials and preclinical studies for efficacy assessment. Our findings reveal that stem cell therapy, particularly in combination with scaffolding materials, holds substantial promise for bone regeneration, spinal stability improvement, and pain mitigation. This integration of stem cell-based methods with conventional treatments may herald a new era in OVCF management, potentially improving patient outcomes. This review advocates for accelerated research and collaborative efforts to translate laboratory breakthroughs into clinical practice, emphasizing the revolutionary impact of regenerative therapies on OVCF management. In summary, this paper positions stem cell therapy at the forefront of innovation for OVCF treatment, stressing the importance of ongoing research and cross-disciplinary collaboration to unlock its full clinical potential. [ABSTRACT FROM AUTHOR]

Background: Early assessment of the risk of nonunion in osteoporotic vertebral compression fracture (OVCF) is beneficial to early clinical decision making. However, a comprehensive understanding of the risk factors for OVCF nonunion is lacking. Methods: We conducted a case–control study to investigate risk factors for OVCF nonunion. Patients who underwent surgery for nonunited OVCFs between January 2011 and December 2021 were eligible for inclusion as cases. Patients with successful OVCF healing confirmed by MRI over the same period were identified as controls. Patient demographics, comorbidities, and fasting blood test data were extracted for analysis. Results: A total of 201 patients with nonunited OVCFs and 1044 controls were included to evaluate the risk factors for nonunited OVCFs. There were statistically significant differences in sex, age, number of patients with hypertension, number of patients on bed rest after OVCF and T-score of BMD between the two groups. Logistic regression showed that female patients had a higher risk of OVCF nonunion than male patients and that smoking, drinking, diabetes, and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. We also found that age, BMD, FBG, and β-CTX were positively correlated with nonunited OVCFs, and that HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Conclusion: Smoking, drinking, diabetes and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. Age, BMD, FBG and β-CTX were positively correlated with nonunited OVCFs, while HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Based on the results of our study, we suggest that bed rest or spinal support for at least 3 consecutive weeks is necessary to reduce the risk of OVCFs nonunion. [ABSTRACT FROM AUTHOR]

Background: To identify some clinical and laboratory independent risk factors for postoperative recompression among elderly osteoporotic vertebral compression fractures (OVCF) patients. Methods: A retrospective analysis was conducted on 287 elderly OVCF patients after percutaneous vertebroplasty (PVP). Relevant risk factors for recompression were screened and further analyzed through multivariate logistic regression. Results: Within postoperative 1 year, recompression had occurred in 72 patients, with an incidence of 25.1% (72/287). Multivariate logistic analysis indicated that mean spinal BMD < − 2.85 (OR: 4.55, 95%CI 2.22–9.31, P < 0.001), ODI ≥ 68.05% (OR: 6.78, 95%CI 3.16–14.55, P < 0.001), PNI score < 43.1 (OR: 2.81, 95%CI 1.34–5.82, P = 0.005), and mFI score ≥ 0.225 (OR: 8.30, 95%CI 3.14–21.95, P < 0.001) were four distinct risk factors that independently contributed to postoperative recompression. Conclusions: Spinal BMD, ODI, PNI and mFI independently predict recompression in OVCF patients after PVP treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of preoperative adaptive behavior training combined with postoperative core muscle training on functional recovery of patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP). Methods: A total of 60 patients with OVCF who planned to undergo PKP in Hefei First People's Hospital from April 2018 to June 2022 were selected as the research subjects, and randomly divided into the control group (n=30) and the observation group (n=30). The control group did not receive adaptive behavior training before operation, but received traditional rehabilitation training after operation. The observation group received adaptive behavior training before operation and core muscle training after operation. Rehabilitation effects, pain degree [Visual Analogue Scale (VAS)], and lumbar vertebral function [Oswestry Disability Index (ODI)] in the two groups were compared. The incidence rates of postoperative complications were recorded. Results: Anterior height (AH), posterior height (PH) and AH/PH in the observation group were higher than those in the control group (P<0.05). Compared with the control group, the observation group had lower VAS scores at 1 week and 2 weeks after operation (P<0.05). There was no significant difference in ODI score between groups at 1 week and 2 weeks after operation(P>0.05). The ODI score of the observation group at 4 weeks after operation was lower than that of the control group (P<0.05). The total incidence rates of complications in the observation group and the control group were 3.33% and 20.00%, with a significant difference between groups(P<0.05). Conclusion: Applying preoperative adaptive training combined with postoperative core muscle training to patients with OVCF can alleviate pain after PKP, effectively improve postoperative lumbar vertebral function, and lower the risk of complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are few studies on the effect of degeneration of paraspinal muscle on osteoporotic vertebral compression refractures treated by percutaneous vertebroplasty in postmenopausal women. This paper intends to reveal the relationship between them. OBJECTIVE: To investigate the relationship between degeneration of paraspinal muscle and osteoporotic vertebral compression refractures in postmenopausal women treated by percutaneous vertebroplasty. METHODS: The medical records of 81 postmenopausal female patients who were admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2018 to March 2021 for osteoporotic vertebral compression fracture and received percutaneous vertebroplasty were retrospectively analyzed. The patients were divided into an osteoporotic vertebral compression refracture group (n=39) and a control group (n=42) according to whether they had osteoporotic vertebral compression refracture after percutaneous vertebroplasty. General data, vertebral bone mineral density, paravertebral crosssectional area and mean CT value (Hu) of the two groups were analyzed. RESULTS AND CONCLUSION: (1) Univariate analysis showed that there was no significant difference in age and mean CT value of psoas major between the two groups (P > 0.05). The body mass index, vertebral bone mineral density, paravertebral cross-sectional area and the mean CT value of the posterior vertebral muscle group in the control group were significantly higher than those in the osteoporotic vertebral compression refracture group (P < 0.05). (2) Multivariate logistic regression analysis showed that low vertebral bone mineral density (OR=0.004, 95%CI: 0.000-0.555, P < 0.05) and low mean CT value of posterior vertebral muscle group (OR=0.940, 95%CI: 0.894-0.988, P < 0.05) were independent risk factors for postmenopausal osteoporotic vertebral compression refracture. (3) It is indicated that degeneration of paraspinal muscle will increase the risk of osteoporotic vertebral compression refractures in patients treated by percutaneous vertebroplasty, especially in postmenopausal women with a low mean CT value of low posterior vertebral muscle group. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporotic vertebral compression fractures have a high rate of recurrent fractures in adjacent vertebrae after percutaneous vertebroplasty, but the cause of their occurrence is still controversial. OBJECTIVE: To explore the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty in patients with single-segment osteoporotic vertebral compression fractures. METHODS: A retrospective analysis was performed in 210 patients admitted to the Fifth Hospital of Wuhan City, Second Affiliated Hospital of Jianghan University from June 2016 to June 2020, who had been diagnosed with new single-segment osteoporotic vertebral compression fractures by X-ray and MRI examinations, and received percutaneous vertebroplasty. The patients were followed up for more than 18 months. The general preoperative data and postoperative indicators were collected. The general preoperative data included age, sex, body mass index, fracture segment location, fracture days, fracture cause, whether accompanied by diabetes mellitus, whether accompanied by renal and thyroid dysfunction, and visual analogue scale score on admission. The postoperative indicators included recovery rate of anterior edge of the vertebral body after operation, degree of dispersion of bone cement, leakage of bone cement, use of bone material, single or bilateral injection of bone cement, recovery rate of the injured vertebral mid-column after operation, local Cobb angle of the injured vertebra after operation. According to their real conditions, the patients were divided into a group without adjacent vertebral re-fractures (n=190) and a group with adjacent vertebral re-fractures (n=20). The presence or absence of postoperative re-fracture of the adjacent vertebrae of the injured spine was used as the dependent variable and the categorical variables such as preoperative general data and postoperative indicators were used as independent variables for statistical analysis. RESULTS AND CONCLUSION: After percutaneous vertebroplasty, patients with adjacent vertebral re-fractures showed significant differences in age, body mass index, postoperative vertebral body anterior edge recovery rate, degree of cement dispersion, and cement leakage from those without adjacent vertebral refractures (P < 0.05). However, sex, time of fracture, cause of fracture, presence of diabetes or kidney disease or thyroid disease, location of the initial vertebral fracture segment, mode of cement injection, local Cobb angle of the injured vertebra, recovery rate of the injured vertebral mid-column, and use of bone tissue were not statistically significant in relation to re-fracture of the adjacent vertebra after percutaneous vertebroplasty (P > 0.05). Multivariate Logistic regression analysis showed that age, vertebral body anterior edge recovery rate and cement leakage were independent risk factors for re-fractures of the adjacent vertebra after percutaneous vertebroplasty. To conclude, age, vertebral body anterior edge recovery rate and leakage of bone cement are the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty. However, factors such as the degree of bone cement dispersion and the local Cobb angle of the injured vertebra were not correlated with adjacent vertebral re-fractures after percutaneous vertebroplasty. [ABSTRACT FROM AUTHOR]

This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post‐operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, −0.60; 95% CI, −1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, −0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, −2.65; 95% CI, −8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post‐operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations. [ABSTRACT FROM AUTHOR]

BackgroundRobot-assisted technology has been widely used in orthopedic surgery, which can provide surgeons with higher accuracy and reduce radiation exposure. In spinal surgery, robots are often used to assist pedicle screw implantation, while there are relatively few studies on robot-assisted percutaneous kyphoplasty (PKP) under local anesthesia.MethodsA total of 96 patients with single-segment OVCF who met the inclusion criteria were included in this study. Fifty-six patients underwent robot-assisted PKP and forty patients underwent conventional PKP by the same group of surgeons. Collect the relevant parameters.ResultsThe puncture time and fluoroscopy times during puncture in the robot group were significantly less than those in the manual group (P

PurposeTo explore the rehabilitation effect and compliance of lumbar and abdominal muscle rehabilitation training in patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous balloon vertebroplasty (PKP).MethodsA total 177 elderly patients with OVCF were divided into rehabilitation group (n = 104) and control group (n = 73) according to whether they received psoas and abdominal muscle rehabilitation training for 3 months after PKP. The differences of general data, orthopaedic rehabilitation, prognosis and bone metabolism were compared between the two groups. All the patients were divided into compliance group (68 cases) and non-compliance group (36 cases) according to compliance. Orthopaedic rehabilitation indicators, prognostic indicators of PKP, and bone metabolism-related parameters were collected for analysis of Chi-square test and Logistic regression. ROC curve was used to analyze the predictive value of bone metabolism related indicators in the compliance of lumbar and abdominal muscle rehabilitation training.ResultsThere was no significant difference in the general data between the rehabilitation training group and the control group (All p > 0.05). Compared with the control group, the Berg balance scale score was significantly increased, while the Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and the proportion of new fractures were significantly decreased in the rehabilitation training group (All p 75 years, severe anxiety, severe pain and postoperative complications were significantly associated with the compliance of psoas and abdominal muscle rehabilitation training in patients with OVCF after PKP. ROC curve analysis showed that BMD T value, OCN, P1NP, β-CTX, or 25-OH-D levels predicted the AUC of rehabilitation training compliance in patients with OVCF after PKP were 0.821, 0.835, 0.736, 0.715, and 0.748, respectively.ConclusionRehabilitation training of lumbar and abdominal muscles can significantly improve the efficacy of PKP, reduce the degree of osteoporosis and improve the prognosis of patients with OVCF. Age, anxiety, pain and postoperative complications were independent risk factors affecting the compliance of psoas and abdominal rehabilitation training in patients with OVCF after PKP.

Wei He,&ast; Quan Zhou,&ast; Jiaheng Lv,&ast; Yujie Shen, Hao Liu, Huilin Yang, Peng Yang, Tao Liu Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Peng Yang; Tao Liu, Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No. 899 Pinhai Road, Suzhou, Jiangsu, 215006, People’s Republic of China, Tel +86-512-67781420, Fax +86-512-67781165, Email ypspine@163.com; liutao821108@163.comBackground: Few studies have focused on percutaneous kyphoplasty (PKP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCFs) with intervertebral cleft (IVC). Hence, the objective of this retrospective study was to compare the clinical and radiographic outcomes of PKP in elderly patients with thoracic OVCFs, with or without IVC.Methods: A total of 106 patients were enrolled in this study and divided into two groups: the IVC group and the NIVC group (without IVC). Radiographic measures included anterior vertebral height (AVH), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical function measures included Oswestry disability index (ODI) and visual analog scale (VAS) scores.Results: There were no significant differences in the preoperative basic data between the groups classified as IVC and NIVC. However, both groups showed significant improvements in AVH and TK throughout the follow-up periods compared to the preoperative measurements (P< 0.05). The recovery of AVH in the IVC group was found to be inferior to that in the NIVC group at 3 years after operation (P< 0.05). There were no significant differences in LL, PI, PT and SS in both groups compared with the preoperative results and no statistically significant differences between the two groups at the same follow-up time (P> 0.05). The VAS and ODI scores during all follow-up periods were significantly lower than those before operation (P< 0.05). At 3 years after operation, the VAS and ODI scores of the IVC group were higher than those of the NIVC group (P< 0.05).Conclusion: PKP is an adoptable measure to treat thoracic OVCFs with or without IVC. Our study revealed that the NIVC group was superior to the IVC group in terms of improved vertebral height and pain recovery at long-term follow-up (3 years).Keywords: percutaneous kyphoplasty, thoracic, osteoporotic vertebral compression fracture, intervertebral cleft, sagittal balance

Objective Romosozumab is increasingly employed to manage osteoporosis. However, no studies have analyzed its effects on recent osteoporotic vertebral compression fractures (OVCFs). Therefore, this study aimed to evaluate the efficacy of romosozumab compared with teriparatide in managing OVCFs. Methods The electronic medical records of postmenopausal patients with recent OVCFs who were administered romosozumab or teriparatide for one year from March 2018 to August 2022 were retrospectively reviewed. We compared the 2 groups for demographics, radiological outcomes (compression ratio, Cobb angle, and bone mineral density [BMD]), and clinical outcomes (Numerical Rating Scale [NRS] for back pain). Results Fifty-five patients with OVCFs, 32 patients treated with romosozumab and 23 with teriparatide, were included in this study. The change of BMD (g/cm2) values was significantly higher (p = 0.016) in the romosozumab (0.04 ± 0.06) than in the teriparatide group (0.00 ± 0.08) in the femur total. Furthermore, in subgroup analysis, the change of BMD (g/cm2) values in the lumbar spine was significantly higher (p = 0.016) in the romosozumab (0.12 ± 0.06) than in the teriparatide group (0.07 ± 0.06) in the lumbar spine. The decrease in NRS was significantly higher (p = 0.013) in the romosozumab (6.6 ± 2.0) than in the teriparatide group (5.5 ± 2.1). However, there was no significant difference in radiologic outcomes between the 2 groups. Conclusion Our findings suggest that romosozumab may be more effective than teriparatide in treating OVCFs in postmenopausal females, particularly in improving BMD and reducing back pain as measured by NRS.