Age-Specific Risk Factors and Time to New Vertebral Fractures After Percutaneous Vertebral Augmentation: Insights From a Retrospective Study.

STUDY

DESIGN

Matched case-control study.

OBJECTIVE

To identify age-specific risk factors and timing of new vertebral fractures following percutaneous vertebral augmentation (PVA) in patients with osteoporotic vertebral compression fractures (OVCF).

SUMMARY OF BACKGROUND DATA: Age is an established independent risk factor for vertebral re-fracture following PVA. However, current clinical guidelines treat the elderly as a homogenous group. It remains unclear whether the "very elderly" (80 y or older) exhibit distinct risk profiles compared with the general elderly, warranting age-stratified prevention strategies to optimize outcomes.

METHODS

This study analyzed OVCF patients undergoing PVA (January 2020 and January 2023). Kaplan-Meier analysis was used to assess time to new fractures between the elderly and very elderly groups. Univariate and multivariate logistic regression identified independent risk factors for new fractures.

RESULTS

From 1220 PVA patients, 75 eligible re-fracture cases, and 150 matched controls were analyzed. In the elderly group, 38 patients experienced new fractures at an average time of 25.72±9.29 months postsurgery, whereas in the very elderly group, 37 patients had fractures significantly earlier, at an average time of 11.49±7.59 months (P<0.001). Adjacent vertebral fractures were more common in the very elderly group (P<0.001), with a higher proportion of severe osteoporosis (T-score ≤-2.5) (P=0.009). Logistic regression identified thoracolumbar junction fractures and cement-endplate contact as key risk factors in the elderly group (P=0.01 and 0.003), while low bone density (P=0.006), cement leakage (P=0.029), and hypertension (P=0.017) were significant risk factors in the very elderly group.

CONCLUSION

We identified significant differences in risk factors and fracture timing between age groups, with the very elderly showing a higher propensity for rapid re-fracture. Therefore, targeted prevention strategies are crucial for reducing fracture risk in both age groups.