Risk Factors for Osteoporotic Vertebral Compression Fracture and Evaluation of Clinical Outcomes of Minimally Invasive Vertebral Augmentation

Study Design Retrospective study and prospective cohort study. Objective Osteoporotic vertebral compression fracture (OVCF) is a frequent and disabling complication of osteoporosis. This study aimed to identify independent risk factors for OVCF, develop and validate a predictive model, and evaluate a risk-stratified surgical strategy comparing percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Methods The study consisted of 3 stages. A retrospective cohort of 316 patients was used to identify risk factors and construct a predictive model, which was externally validated in an independent cohort of 274 patients. A prospective cohort of 206 OVCF patients was then enrolled to compare clinical and radiographic outcomes of PVP and PKP. Patients with a predicted risk score >0.5 were classified as high risk and preferentially treated with PKP. Pain, functional outcomes, radiographic parameters, and complications were evaluated preoperatively and at 1 week, 3 months, and 6 months postoperatively. Results Multivariate analysis identified age ≥70 years, body mass index <20 kg/m 2 , bone mineral density T-score ≤−3.0, history of falls, and 25-hydroxyvitamin D deficiency as independent risk factors. The predictive model showed good calibration and clinical utility. Both PVP and PKP significantly improved pain and function. Within the risk-stratified strategy, PKP was associated with greater improvements in pain relief, functional recovery, and radiographic restoration, as well as lower rates of cement leakage and refracture. Conclusion A validated predictive model for OVCF was established and may support individualized surgical decision-making. Risk-stratified use of PKP appears to provide superior short- to mid-term outcomes in high-risk patients.