Denosumab treatment after percutaneous vertebroplasty for osteoporotic vertebral compression fractures: Long-term follow-up of pain relief, bone mineral density changes, and risk of refracture

Objective To investigate the effects of denosumab on pain relief, bone mineral density (BMD), and refracture risk during long-term follow-up in patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebroplasty, and to identify factors associated with refracture. Methods This retrospective study included 396 OVCF patients who underwent percutaneous vertebroplasty and received denosumab between January 2021 and June 2023. Patients were classified into a completed-treatment group ( n = 184) and a discontinued-treatment group ( n = 212). After 1:1 propensity score matching, 101 patients were included in each group. Changes in visual analog scale (VAS) scores and lumbar spine and femoral neck T-score were compared over 24 months. Refracture risk was assessed using Kaplan–Meier analysis and multivariable Cox regression in the matched cohort. Results After matching, baseline characteristics were well balanced between groups. Over 24 months of follow-up, the completed-treatment group showed significantly lower VAS scores and greater improvements in lumbar spine and femoral neck T-score compared with the discontinued-treatment group. The incidence of refracture was significantly lower in the completed-treatment group. In the PSM cohort, multivariable Cox regression analysis demonstrated that completed denosumab treatment was independently associated with a lower risk of refracture (HR = 0.314, 95% CI 0.125–0.792, P = 0.014). Conclusion In patients with OVCF treated with percutaneous vertebroplasty, persistent denosumab therapy for at least 24 months is associated with sustained pain relief, improved BMD, and a lower risk of refracture, underscoring the importance of long-term treatment adherence.