Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

Abstract

Background

Postoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients’ underlying medical conditions on the refracture of osteoporotic compression fractures following surgery.

Methods

A retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses.

Results

Among the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture (P = 0.018, OR = 0.548), while alcohol intake ≥ 10years (P = 0.003, OR = 2.165), mental abnormality (P < 0.001, OR = 4.093), scoliosis (P < 0.001, OR = 6.243), chronic kidney disease (P = 0.002, OR = 2.208), and traumatic injuries (P = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis.

Conclusions

Hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-024-04907-5.

Background

Effective osteoporosis prevention and control, together with a decrease in the number of osteoporotic fractures, are critical to mitigating the disease’s detrimental effects on public health and the socioeconomic fabric [1]. The incidence of osteoporosis is rising quickly worldwide [2]. Osteoporotic vertebral compression fractures, or OVCFs, are becoming more prevalent and frequent in older persons due to the aging population’s steady growth and the variety of underlying disorders that affect the aged. Elderly people who suffer from fractures have discomfort, reduced mobility, a reduction in quality of life, and in severe situations, a higher death rate [3]. Percutaneous vertebroplasty (PVP), as a new minimally invasive spine surgery technique, provides pain relief in over 90% of cases [4, 5], and is characterized by minimal trauma, immediate stabilization of fractures, and early recovery of mobility, thus reducing complications from bed rest. With the widespread performance of the surgery, the incidence of postoperative vertebral re-fracture is also increasing, reaching 10.2–15.6% [6, 7]. This study collects cases of osteoporotic compressive fractures with underlying diseases and analyzes the risk factors related to post-PVP re-fractures based on the characteristics of underlying diseases in the elderly. This is to provide a basis for further treatment of underlying diseases and to reduce the incidence of postoperative vertebral re-fracture. Such analysis can guide clinical practice, reduce the rate of re-fractures while treating underlying diseases, and benefit health management.

Method

Study design and data source

OVCF, a most common type of fracture in patients with osteoporosis, can cause chronic back pain, limited mobility, impaired physical function, reduced quality of life and increased mortality in older patients [8]. Firstly, the system retrieved the OVCFs patients who underwent PVP surgery from August 2012 to August 2023 and met the inclusion criteria. Secondly, among them, the osteoporosis patients with underlying diseases were further screened and divided into the re-fracture group and the non-re-fracture group according to the research criteria. Thirdly, the selected samples were used for statistical analysis by SPSS software.

Inclusion criteria for patients undergoing surgery for the first time: (1) A certain degree of preoperative low back pain, often accompanied by the inability to turn over, or the feeling of weakness in getting up, and localised spinous processes. (2) Fresh vertebral compression fracture, i.e., low T1 signal and high or slightly high T2 signal on MRI, combined with the above symptoms, was clearly identified by preoperative X-ray, CT and MRI. (3) Bone density of lumbar vertebrae measured by dual-energy X-ray bone densitometry or QCT, with a T-value of <-2.5 SD or less than 80 mg/dL, combined with a fracture and low-energy injury. Exclusion criteria: (1) pathological fracture due to spinal infection or tumor. (2) Vertebral fracture due to high-energy injury.

Inclusion criteria for study cases: (1) patients with combined underlying diseases were statistically classified into different segments according to disease; (2) patients with original segmental fractures considered as re-fractures; (3) patients with conservative re-fractures. Exclusion criteria: (1) pathological fractures clearly caused by spinal infections or tumors; (2) re-fractures of vertebrae clearly caused by high-energy injuries; (3) patients who were bedridden for a long time.

Methodologies

General data and basic disease data of the patients were collected through the medical record and imaging system of Hospital Information System (HIS).

Surgical data: In this study, PVP surgery was performed by unilateral puncture, bone cement was used with OSTEOPAL V from Germany, and instruments were used with Guanlong instruments, and the operation time was 10–20 min.

In our study, the patients were divided into re-fracture group and non-re-fracture group, and the related risk factors were included in the single-factor study, which was statistically processed to screen out the risk factors. The screened risk factors were further analysed by multivariate logistic regression to analyse the independent risk factors and ROC curve scale analysis.

Postoperative treatment and follow-up: On the next day after surgery, the patient wore a thoracolumbar support to get out of bed, and was informed of the systematic anti-osteoporosis medication after discharge from the hospital. Follow-up visits were made by self-visit, telephone, and outpatient review for symptom aggravation, and a schedule was established to treat cases with vertebral re-fracture as re-fracture on the basis of the 2nd admission, outpatient confirmation, and outpatient visit.

Statistical analysis

The samples were statistically analysed using SPSS 23.00 software (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). Qualitative data were analysed using chi-square test, with two-sided value of 0.05. Combined underlying disease re-fracture and non-fracture patients were analysed statistically significant using one-way analysis, and statistically different cases were analysed statistically differently by applying multivariate Logistic regression analysis and stepwise regression analysis with P < 0.05 as the difference statistically significant, and ROC curves were analysed as much as possible to reflect the scale analysis.

Results

Participant characteristics

The system retrieved 2,383 patients admitted to OVCFs for PVP from August 2012 to August 2023. Then, 183 cases with re-fractures and 367 patients with non-re- fractures, totaling 550 patients, met the research criteria. The flowchart of patient’s selection was showed in Fig. 1. Refracture incidence was 33.3%, while the overall effective sample fraction of patients gathered was 23.1%. In comparison to patients who did not have a re-fracture, univariate statistical analysis revealed (Table 1) that patients who had a re-fracture had higher rates of long-term alcohol intake (P < 0.05), operated vertebrae ≤ 1 (P < 0.05), hypertension (P < 0.05), a low percentage of COPD, diabetes mellitus, post-stroke sequelae (P < 0.05), conservatively treated coronary artery disease (P < 0.05), trauma (P < 0.05), a high percentage of mental abnormalities (P < 0.05), scoliosis (P < 0.05), and chronic kidney disease (P < 0.05). shows that the other variables did not differ statistically (P > 0.05).

Fig. 1.

The flowchart of patient’s selection

Table 1.

Univariate analysis of the factors influencing re-fracture of compression fractures

	re-fracture(n = 183)	No re-fractures(n = 370)	Z/X²	P
age	69.65 ± 7.46	69.99 ± 6.36	-1.266	0.205
genders			0.029	0.865
male	84(33.5%)	167(66.5%)
females	99(32.8%)	200(67.2%)
occupation			0.23	0.631
farmers	131(32.5%)	272(67.5%)
retired	52(34.7%)	98(65.3%)
Smoking ≥ 10Y			0.843	0.358
No	123(34.5%)	234(65.5%)
Yes	60(30.6%)	136(69.4%)
Alcohol ≥ 10Y			6.305	0.012
No	110(29.5%)	263(70.5%)
Yes	72(40.2%)	107(59.8%)
Medicalinsurance			0.564	0.453
No	10(40%)	15(60%)
Yes	173(32.8%)	355(67.2%)
vertebrae ≤ 1			79.557	<0.001
No	46(16%)	242(84%)
Yes	137(51.7%)	128(48.3%)
hypertensive			13.74	<0.001
No	88(42.7%)	118(57.3%)
Yes	95(27.4%)	252(72.6%)
T2DM			95.999	<0.001
No	52(16.3%)	267(83.7%)
Yes	131(56%)	103(44%)
COPD			5.234	0.022
No	96(38.1%)	156(61.9%)
Yes	87(28.9%)	214(71.1%)
strokes			1.228	0.268
No	109(35%)	202(65%)
Yes	74(30.6%)	168(69.4%)
Post-stroke stroke			29.282	<0.001
No	113(27%)	306(73%)
Yes	70(52.2%)	64(47.8%)
CHD conservative treatment			86.034	<0.001
NO	52(16.7%)	259(83.3%)
YES	131(54.1%)	111(45.9%)
Coronary stenting			0.154	0.695
No	155(32.8%)	318(67.2%)
Yes	28(35%)	52(65%)
trauma			82.754	<0.001
No	58(17.8%)	267(82.2%)
Yes	125(54.8%)	103(45.2%)
psychiatric			85.657	<0.001
No	97(22.9%)	327(77.1%)
Yes	86(66.7%)	43(33.3%)
osteoarthritis			1.871	0.171
No	115(35.4%)	210(64.6%)
Yes	68(29.8%)	160(70.2%)
gout			2.628	0.105
No	171(32.4%)	357(67.6%)
Yes	12(48%)	13(52%)
malignant tumor			1.083	0.298
No	175(32.7%)	360(67.3%)
Yes	8(44.4%)	10(55.6%)
kyphosis			148.389	<0.001
No	21(7.9%)	246(92.1%)
Yes	162(56.6%)	124(43.4%)
operating			1.904	0.168
No	170(32.4%)	354(67.6%)
Yes	13(44.8%)	16(55.2%)
CKD			77.699	<0.001
No	85(21.7%)	306(78.3%)
Yes	98(60.5%)	64(39.5%)

Association of re-fracture risk

According to the logistic regression model with restricted cubic spline analysis, indicators that were statistically significant -in the univariate analysis were the independent variables in binary logistic regression analyses, where the dependent variable was whether or not a re-fracture occurred. As shown in Table ​2, According to the findings, trauma (RR = 1.36, 95% CI = 1.19–1.56, P < 0.001), mental abnormalities (OR = 3.512, 95% CI = 0.912–2.508, P < 0.029), scoliosis (OR = 6.243, 95% CI = 3.365–11.582, P < 0.001), chronic kidney illness (OR = 2.208, 95% CI = 1.323–3.686, P < 0.002), and alcohol intake for more than ten years (OR = 2.165, 95% CI = 1.305–3.591, P < 0.003)were risk factors, while was found to be a protective factor hypertension disease (OR = 0.548, 95% CI = 0.334–0.901, P < 0.018). Based on the magnitude of the absolute value of the standardized partial regression coefficient, multiple linear stepwise regression analysis revealed that scoliosis was the factor that affected re-fracture the most, other factors that were found to have an impact included mental abnormalities, malignant neoplasms, chronic renal disease, alcohol consumption ≥ 10 years, diabetes mellitus, conservative treatment of coronary artery disease, hypertensive disease, and trauma.

Table 2.

Results of binary logistic regression analysis of compression fracture re-fracture

	B	S.E.	Wald	P	OR	95%CI
Alcohol ≥ 10Y	0.772	0.258	8.941	0.003	2.165	(1.305～3.591)
vertebrae ≤ 1	0.15	0.32	0.22	0.639	1.162	(0.62～2.176)
hypertensive	-0.601	0.253	5.627	0.018	0.548	(0.334～0.901)
T2DM	0.466	0.296	2.479	0.115	1.594	(0.892～2.849)
COPD	-0.307	0.238	1.654	0.198	0.736	(0.461～1.174)
Post-stroke stroke	0.09	0.286	0.099	0.753	1.094	(0.625～1.918)
CHD conservative treatment	0.369	0.284	1.687	0.194	1.446	(0.829～2.523)
trauma	0.414	0.258	2.567	0.029	3.512	(0.912～2.508)
psychiatric	1.409	0.293	23.092	<0.001	4.093	(2.304～7.272)
kyphosis	1.831	0.315	33.743	<0.001	6.243	(3.365～11.582)
CKD	0.792	0.261	9.19	0.002	2.208	(1.323～3.686)

Sensitivity analysis

In addition, we conducted stratified analyses the incidence of re-fracture was positively correlated with the following conditions: scoliosis, mental abnormalities, malignant tumors, chronic kidney disease, trauma, alcohol intake for ≥ 10 years, diabetes mellitus, and conservative treatment of coronary artery disease. Conversely, there is a negative connection between both and the dependant variable and the likelihood of re-fracture when one has hypertension condition. To assess the diagnostic value of the above indicators (Table 3).

Table 3.

Multiple linear stepwise regression analysis of factors influencing re-fracture

	B	S.E.	β	T	P
constant	-0.07	0.144		-0.49	0.625
X1	0.273	0.041	0.29	6.685	<0.001
X2	0.254	0.04	0.228	6.344	<0.001
X3	0.154	0.039	0.149	3.971	<0.001
X4	0.1	0.034	0.1	2.984	0.003
X5	0.086	0.04	0.091	2.179	0.03
X6	-0.085	0.033	-0.088	-2.587	0.01
X7	0.099	0.04	0.104	2.445	0.015
X8	0.21	0.09	0.079	2.331	0.02
X9	0.051	0.039	0.074	2.531	0.025

X1: kyphosis; X2: psychiatric; X3:CKD; X4: Alcohol ≥ 10Y; X5: CHD conservative treatment; X6: hypertensive; X7: T2DM; X8: malignant tumor; X9: trauma

ROC curves were created (Fig. 2), and the results revealed that the following conditions had AUCs: scoliosis AUC = 0.775 (P < 0.001), mental abnormality AUC = 0.675 (P < 0.001), hypertension AUC = 0.58 (P < 0.002), alcohol intake ≥ 10years AUC = 0.553 (P < 0.442), and chronic kidney disease AUC = 0.68 (P < 0.001) (Table 4) (Note: the curve did not analyze non-underlying disorders; trauma was a risk for re-fracture).

Fig. 2.

ROC curve for diagnostic indicators of re-fracture. The diagnostic value of the above indicators was further evaluated by constructing ROC curves based on the results of logistic regression analyses for alcohol intake≥10 years, hypertensive disorders, mental abnormalities, scoliosis, and chronic kidney disease

Table 4.

ROC curve for diagnostic indicators of re-fracture

Diagnostic indicators	AUC	S.E.	P	95%CI
Alcohol ≥ 10Y	0.553	0.026	0.042	(0.502～0.605)
hypertensive	0.58	0.026	0.002	(0.528～0.631)
mental abnormalities	0.675	0.026	<0.001	(0.625～0.726)
scoliosis	0.775	0.021	<0.001	(0.734～0.815)
CKD	0.68	0.025	<0.001	(0.63～0.73)

Typical case

Female, year of age 72, history of previous alcohol intake for 30 years, coronary artery disease with stent implantation for 4 years, scoliosis 20 years, chronic kidney disease for 6 years; The patient was admitted to our department with complaint of “back pain and limited mobility” three times for treatment. Preoperative examinations were conducted to confirm the diagnosis of osteoporotic compression fractures. The surgical segments of the three times operation are L1-L3 (Fig. 3), T9/10 (Fig. 4), and T11/12 (Fig. 5), respectively. After undergoing the three times PVP surgery, the patient recovered well without any complications. In addition, due to the patient had a systematic anti-osteoporosis treatment (twelve months of osteotriol, salmon calcitonin, and ibandronate therapy) after the first PVP surgery. The BMD (Figs. 6, 7 and 8) of the patient was also gradually increasing.

Fig. 3.

The pre- and postoperative imaging data of the typical case under the first PVP surgery. The A is an MRI image of the patient had the first fracture showed the fresh compression fracture of the L1/2/3 vertebral body. The B is a positive X-ray of the lumbar spine of that patient showed the instability-causing scoliosis and the compression fracture of the L1/2/3 vertebral body. The C is a lateral X-ray of the lumbar spine showed the L1, L2, and L3 vertebral bodies of this patient underwent the PVP surgery

Fig. 4.

The imaging data of the typical case before the second PVP surgery. A is an MRI image showed the T9 and T10 were fresh compression fracture. B is a lateral X-ray of the thoracic spine after the second PVP surgery. C is a posteroanterior X-ray of the thoracic spine after the second PVP surgery

Fig. 5.

The pre- and post-imaging data of the typical case about the third PVP surgery. A is an MRI image showed the T11 and T12 were fresh compression fracture. B is a lateral X-ray of the thoracic spine after the third PVP surgery

Fig. 6.

The BMD of the typical case before the first PVP surgery. The initial QCT BMD test resulted in 36.3 mg/cm³

Fig. 7.

The BMD of the typical case before the second PVP surgery. The QCT bone density test at the second fracture showed 36.8 mg/cm³

Fig. 8.

The BMD of the typical case before the third PVP surgery. The QCT bone density test at the third fracture showed 75.8 mg/cm³

Discussion

In the present study, elderly patients with OVCF have a steadily rising frequency of this frequent clinical problem, which can result in several different surgical procedures. Numerous researches have been conducted on re-fracture following vertebroplasty, but no clear consensus has been reached to date [7, 9–12]. The primary goal of treating and preventing osteoporosis is to reduce fractures and their recurrence, particularly in patients with coexisting medical conditions. Whether or not there is a risk factor for a connection between the disease has not yet been documented either nationally or worldwide. Fractures are a serious side effect of osteoporosis with a high disease burden. There has been debate regarding the cause of adjacent vertebrae re-fracture [13, 14]. Some researchers have calculated the relevant factors using finite element simulation and have concluded that the occurrence of postoperative adjacent vertebrae re-fracture is due to the natural development of osteoporosis and that there is little biomechanical change to the adjacent vertebrae after PVP/PKP [13]. Su [15] gathered more than 100 patients for a cohort study on vertebral kyphoplasty for the treatment of osteoporotic compression fractures. Of these, 27.8% had refractures, and 68% of them happened in adjacent vertebrae. This rate of refractures is comparable to the 33.3% refracture rate of the data gathered for this paper and satisfies the statistical requirements. According to Ning et al’s study [16], there was an increased likelihood of secondary surrounding vertebrae fracture following the initial multisegmental vertebral fracture following PKP. Compared to the first single vertebral fracture treated with bone cement, there was a greater chance of fracture. The literature indicates that there are numerous potential causes of refracture following bone cementing; however, a greater amount of research has concentrated on factors like advanced age, adjacent vertebral fractures, cement dosage, cement distribution, cemented intervertebral space leakage, bone mineral density (BMD) [17], and abnormalities of the vertebral force line. Reduced BMD from underlying conditions like osteoporosis might raise the risk of refracture following surgery. BMD can be impacted by illnesses that impact the metabolism of calcium and vitamin D.

OVCF are more frequent in females; however, the multiple comorbidities that affected males when involved in PFFs lead to problematic functional recovery and higher mortality. Therefore, understanding and knowing these gender differences is fundamental to communicate adequately with patients and relatives [18]. Certain long-term conditions, such diabetes mellitus or chronic kidney disease, can hinder bone mending and raise the possibility of another fracture. Co-morbidities between osteoporosis and coronary heart disease are closely observed, and the likelihood of osteoporosis in patients with coronary heart disease is significant. The survey found that patients with coronary artery disease had a higher prevalence of osteoporosis than patients without the condition [19]. Univariate statistical analysis also revealed that conservative treatment of coronary artery disease was an influencing factor for re-fracture. A comprehensive conclusion regarding the potential osteoprotective effect of statin anti-atherosclerotic therapies cannot be drawn from the current study’s results alone. There is a close correlation between geriatric osteoporosis and hypertension, coronary heart disease, and cerebral infarction [20]. Long-term oral treatment with four types of blood pressure control drugs via coronary stent implantation, anticoagulant drugs like aspirin and clopidogrel, and antilipidemic drugs may increase the risk of re-fracture of osteoporosis in the elderly.

Regression analysis was used to examine statistical data of patients who had been drinking for more than ten years. The results showed that alcohol intake was a significant risk factor for re-fracture; It has been demonstrated that long-term smoking, alcohol consumption and other unhealthy lifestyle habits are related to the occurrence of OP, and long-term excessive alcohol intake can cause alcohol-induced osteoporosis (AOP) [21]. The results of this study concluded that scoliosis is a risk factor for re-fracture and that scoliosis has the greatest impact on re-fracture. It has been suggested that vertebral kyphosis or spinal force line abnormalities alter the vertebral stress-bearing state, leading to the occurrence of re-fracture [22]. Malnutrition, which is common in the elderly [23], can impair recovery and bone healing [24, 25]. Adequate intake of protein, calcium, and vitamin D is crucial for bone health [26, 27]. This suggests that scoliosis may be associated with re-fracture due to abnormal force lines. In patients with severe degenerative scoliosis, it is important to be alert to the risk of re-fracture, and early osteoporosis prevention and intervention, including the use of a brace, is a good choice.

Mental abnormality is the most influential factor after scoliosis, first of all, patients often need to take antipsychotic drugs for a long period of time, which leads to a reduction in the amount of exercise and poor nutritional status of the patients, and at the same time, the drugs will also affect the body mass and sex hormone levels [28]. which leads to the patients are more prone to osteoporosis, which correspondingly increases the risk of re-fracture.

Limited mobility or a sedentary lifestyle can lead to muscle weakness and poor balance, increasing the risk of falls and subsequent fractures. Stroke is a major disease that seriously jeopardizes the health and quality of life of the population, however, osteoporosis and subsequent fractures are recognized complications of stroke [29]. Post-stroke sequelae were re-fracture factors in univariate analysis, and regression analysis was not statistically significant. The mechanisms of post-stroke osteoporosis are complex, including braking, weight loss, malnutrition, pharmacological factors, neuroendocrine and other factors such as age and gender, especially in patients with sequelae of stroke who suffer from a serious decline in quality of life, even long-term bed rest resulting in disuse Osteoporosis (DOP), accompanied by this type of underlying disease patients often lower BMD values and not easy to correct [27], which leads to a corresponding increase in the risk of re-fracture, but whether bedridden mobility is a protective factor for re-fracture, to be further studied. Effective rehabilitation is key to improving mobility and strength, which can help prevent falls and re-fractures.

In traditional Chinese medicine, the kidney is a functional concept that regulates water metabolism and is closely related to the urinary system, bones, metabolism, etc. According to the theory of traditional Chinese medicine, “the kidney is the master of bone” [30], and people with chronic kidney disease (CKD) (OR = 2.208, 95% CI = 1.323–3.686, P < 0.002) have a higher risk of multifactorial VD deficiency, which is closely associated with poor outcomes, including bone disease, cardiovascular disease and higher mortality [31]. The finding that in patients with chronic kidney disease, decreased renal compensatory function increases the risk of osteoporotic re-fracture is also in line with conventional medical opinion. Certain medications, including glucocorticoids and some anticoagulants, can weaken bone structure or interfere with bone metabolism, leading to a higher risk of fractures.

Diseases like rheumatoid arthritis, hyperthyroidism, or chronic obstructive pulmonary disease (COPD) (OR = 0.736, 95% CI = 0.461–1.174, P < 0.198) can exacerbate bone fragility [32]. Disorders of the endocrine system, such as hyperparathyroidism or insulin resistance, can influence bone metabolism and fracture risk.

Re-fracture risk can be increased by any disease that raises the risk of falling [33], including neurological illnesses, visual impairment, and polypharmacy. Trauma does not belong to the category of underlying diseases, but it is a type of pathogenic factor for the OVCF [34]. In a previous study, women with a history of high traumatic fractures had a 34% higher risk of future fractures and women with an initial history of low traumatic fractures had a 31% higher risk of future fractures compared to women with no history of fractures [35]. These findings all suggest that any prior fracture, regardless of the degree of trauma, may indicate underlying skeletal fragility and an increased risk for future fracture. In addition, most women with a history of low trauma fractures have low BMD, and women with both low BMD and prior fractures have a very high risk of future fractures [36]. Therefore, an important clinical goal is to prevent the bone loss that leads to the first fracture, because this bone loss is largely irreversible by the time the first fracture occurs.

Numerous studies have revealed that have linked the significant and prevalent chronic illness of hypertension to BMD. There is a positive phase between hypertension and lumbar spine BMD, however the results are conflicting [37]. Patients with hypertensive diseases have an increased risk of acquiring osteoporosis. In the elderly, hypertension and osteoporosis have a similar pathogenetic etiology [38]. AUC = 0.58 (P < 0.05) for hypertension in this study indicates a statistically significant difference; nevertheless, hypertension disease lowers the risk of re-fracture, and the two have a negative association with the dependent variable, which acts as a preventive factor against re-fracture. More research can be done to determine whether it has anything to do with using medication to control hypertension.

It is important to underscore the potential impact of depression, cognitive impairment, and lack of social support can affect an elderly patient’s ability to follow postoperative care instructions and engage in preventive measures [39]. Chronic inflammation, which can be present in many systemic diseases, may negatively impact bone healing and turnover [40]. Some individuals may have a genetic predisposition to poor bone quality or diseases that affect bone health.

Therefore, as the use of bone cement increases, the number of patients suffering from provertebral fractures will also increase. Because of this, it is imperative to manage and prevent osteoporosis and to treat the underlying condition as soon as possible, all the while keeping in mind the risk of refracture. Patients with OVCF should have their underlying diseases and other relevant risk factors considered when creating a treatment plan. In particular, alcohol use, mental illness, scoliosis, chronic kidney disease, and hypertension as a protective factor should be taken into consideration. There is no way to prevent trauma, and of all the causes, scoliosis has the greatest impact. Weighing the benefits and drawbacks of proactive, tailored treatment plans for the underlying condition is essential during the preoperative evaluation, intraoperative procedure, and postoperative patient care. In addition, this study did not address all characteristics that may be associated with scoliosis; hence, future research is necessary to better understand the interactions between these variables. Moreover, the patient selection was modest and this was not a multicenter large-sample investigation.

There are some limitations to this study. Firstly, the patients included are all Chinese, which may not be representative of all risk factors. Secondly, all cases were from a single hospital, so it remains necessary to perform large-sample multicenter prospective studies in the future. Thirdly, the condition of elderly people is complex and difficult to homogenize analysis and statistics, such as the length of medical history, different types, doses, and frequencies of drug treatment, etc. Furthermore, the different compliance of elderly people with anti-osteoporosis drug treatment may also have a impact on the research results.

Conclusion

In general, the present study revealed the hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture. More importantly, based on these risk factors, surgeons can optimize the patient’s preoperative condition and develop more comprehensive treatment plans.

Electronic supplementary material

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Abbreviations

OVCF

Osteoporotic Vertebral Compression Fractures

PVP

Percutaneous VertebroPlasty

PKP

Percutaneous KyphoPlasty

DOP

Disuse Osteoporosis

BMD

Bone Mineral Density

AOP

Alcohol-induced OsteoPorosis

CKD

Chronic Kidney Disease

COPD

Chronic Obstructive Pulmonary Disease

Author contributions

Methodology, Conceptualization, Software, Data curation, Investigation, Software, Validation, Writing – review &; editing: QWL, BQ; Conceptualization, Methodology, Data curation, Writing – original draft, Investigation, Supervision, Writing – review & editing: XQK and BQ; Surgical operation Data curation, Investigation, Writing – review &; editing: CYM, QWL and XQK. Bao Qi made significant contributions in the major revision of this article; All authors reviewed the manuscript.

Funding

This research was supported by the Jining City Bureau of Science and Technology. Number: 2023YXNS039.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Ethical approval for the Clinical Diseases Study was obtained from the Affiliated Hospital of Jining Medical University, and the study has been conducted according to the principles expressed in the Declaration of Helsinki. The interviews were conducted by Re-operation, all respondents read a confidentiality statement when first contacted, and they give verbal informed understand and consent by agreeing to do the interview. This consent procedure was approved by the Affiliated Hospital of Jining Medical University.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.