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Meta-Analysis
. 2025 Aug 16;26(1):791.
doi: 10.1186/s12891-025-08998-x.

Risk factors for subsequent vertebral fractures after percutaneous vertebral augmentation in Asian populations: a systematic review and meta-analysis

Weijie Zheng #  1   2 , Jiexin Huang #  1 , Liang Jin #  1   2 , Qiaoli Zhang #  1   2 , TianFeng Li  1   2 , WanChen Gong  1   2 , Yuchen Xia  1   2 , Zhengyi Lin  1   2 , Fei Zhou  1 , Chengwu Lu  1 , Libao Zhang  1 , Changhui Xue  1 , Hong Ye  3   4 , Linfeng Wang  5   6
Affiliations
Meta-Analysis

Risk factors for subsequent vertebral fractures after percutaneous vertebral augmentation in Asian populations: a systematic review and meta-analysis

Weijie Zheng et al. BMC Musculoskelet Disord. .

Abstract

Objective: To identify the risk factors for subsequent vertebral fractures after percutaneous vertebral augmentation through the meta-analysis.

Methods: Articles from 2019 to 2024 were retrieved from PubMed, Cochrane Library, Embase, and Web of Science. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS), while data analysis was performed with R (The R Project for Statistical Computing).

Results: Fourteen articles comprising data from 5,673 patients were included in the analysis. Statistically significant differences were identified for age, gender, T-score (measured by dual-energy X-ray absorptiometry), body mass index (BMI), Computed tomography Hounsfield unit (CT HU) value, intravertebral cleft (IVC), multi-segment vertebral fractures, and bone cement leakage. In contrast, no statistically significant differences were observed for hypertension history, diabetes history, thoracolumbar vertebral fracture, postoperative Cobb angle, surgical method（percutaneous vertebroplasty/percutaneous kyphoplasty）, puncture method (unilateral/bilateral puncture), or bone cement volume.

Conclusion: In Asian populations, advanced age, female, low T-score, low BMI, low CT HU values, presence of IVC, multi-segment vertebral fractures, and bone cement leakage are identified as significant risk factors for subsequent vertebral fractures following PVA. Conversely, a history of anti-osteoporosis treatment is identified as a protective factor, whereas hypertension history, diabetes history, thoracolumbar vertebral fracture, postoperative Cobb angle, surgical method, puncture method, and bone cement volume demonstrate no significant correlation with subsequent vertebral fractures after PVA.

Keywords: Meta-Analysis; Osteoporotic vertebral compression fracture; Percutaneous vertebral augmentation; Subsequent vertebral fractures.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institutional Review Board approval was not required because of the nature of this article. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the evidence search and selection process
Fig. 2
Fig. 2
Forest plots for outcomes on the risk of gender; CI, confidence interval; OR, odds ratio
Fig. 3
Fig. 3
Forest plots for outcomes on the risk of age; CI, confidence interval; OR, odds ratio; RF, refracture; NRF, no-refracture
Fig. 4
Fig. 4
Forest plots for outcomes on the risk of BMI; CI, confidence interval; OR, odds ratio; BMI, body mass index; RF, refracture; NRF, no-refracture
Fig. 5
Fig. 5
Forest plots for outcomes on the risk of T-score; CI, confidence interval; OR, odds ratio; RF, refracture; NRF, no-refracture
Fig. 6
Fig. 6
Forest plots for outcomes on the risk of CT HU value; CI, confidence interval; OR, odds ratio; CT HU value, Computed tomography Hounsfield unit value; RF, refracture; NRF, no-refracture
Fig. 7
Fig. 7
Forest plots for outcomes on the risk of anti-osteoporotic treatment; CI, confidence interval; OR, odds ratio; AOT, anti-osteoporotic treatment
Fig. 8
Fig. 8
Forest plots for outcomes on the risk of IVC; CI, confidence interval; OR, odds ratio; IVC, Intravertebral cleft
Fig. 9
Fig. 9
Forest plots for outcomes on the risk of multi-segment fractures; CI, confidence interval; OR, odds ratio
Fig. 10
Fig. 10
Forest plots for outcomes on the risk of bone cement leakage; CI, confidence interval; OR, odds ratio; BCL, bone cement leakage
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