Risk factors for adjacent vertebral fracture after PVP in patients with OVCF

Objective To identify the risk factors and evaluate the predictive performance for adjacent vertebral fracture (AVF) after Percutaneous vertebroplasty (PVP). Methods In this retrospective study, 429 patients with osteoporotic vertebral compression fractures who underwent initial single-level PVP at the Fourth Affiliated Hospital of Xinjiang Medical University between January 2019 and December 2024. Patients were categorized into an AVF group ( n = 143) and a non-AVF group ( n = 286) based on the occurrence of postoperative AVF. Collected variables included age, lumbar spine bone mineral density (BMD), body mass index (BMI), and bone cement leakage. Univariate analysis analyses identified significant variables ( P < 0.05), which were subsequently entered into a binary logistic regression model to determine independent risk factors. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Results Univariate analysis indicated that the AVF group was significantly older (76.357 ± 7.698 vs. 72.608 ± 9.024 years, P < 0.001), had lower BMD T-scores (−3.1 ± 0.6 vs. −2.4 ± 0.8, P < 0.001), and had a lower BMI (22.18 ± 3.28 vs. 24.75 ± 3.52 kg/m 2 , P < 0.001). Logistic regression confirmed that advanced age (OR = 1.045, 95% CI: 1.018–1.074, P = 0.001) and low BMD (analyzed as continuous variable: OR = 2.85 per SD decrease, 95% CI: 2.12–3.82, P < 0.001) were independent risk factors. predictive performance analysis showed that age had an AUC of 0.623 (sensitivity 56.6%, specificity 62.6%), and BMD had an AUC of 0.629 (sensitivity 86.0%, specificity 39.9%). A combined prediction model achieved an AUC of 0.706 (95% CI: 0.565–0.976). Conclusion Advanced age and low bone mineral density are independent risk factors for AVF after PVP, with OR = 1.045 per year of age and OR = 2.85 per SD decrease in BMD T-score. Although the predictive value of individual indicators is limited (AUC < 0.7), a comprehensive model (AUC = 0.706) achieves moderate accuracy suitable for preliminary risk stratification, supporting the prioritization of systemic osteoporosis management over surgical technical details in prevention strategies.