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

STUDY DESIGN: Matched case-control study.