Objective To explore the influencing factors of adjacent vertebral fracture (AVF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF) and to analyze the predictive value of the vertebral height loss rate.

Methods A total of 121 patients with OVCF were selected and divided into AVF group (n=31) and non-AVF group (n=90) based on occurrence of AVF after PKP. General patient data were collected, and preoperative vertebral height loss rates were assessed. Multivariate logistic regression analysis was used to screen for factors influencing AVF after PKP in OVCF patients. The predictive value of preoperative vertebral height loss rate for AVF after PKP in OVCF patients was analyzed using the receiver operating characteristic (ROC) curve.

Results Compared with the non-AVF group, the AVF group had a higher proportion of patients with a history of glucocorticoid use and bone cement leakage, an increased preoperative vertebral height loss rate, and decreased bone mineral density (BMD), with statistically significant differences (P < 0.05). Multivariate logistic regression analysis revealed that BMD (OR=2.002, 95%CI, 1.613 to 3.025), bone cement leakage (OR=1.703, 95%CI, 1.575 to 2.580), and preoperative vertebral height loss rate (OR=1.903, 95%CI, 1.402 to 2.731) were independent influencing factors for AVF after PKP in OVCF patients (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) for preoperativevertebral height loss rate in predicting AVF after PKP in OVCF patients was 0.759, with a cutoff value of 59.96%, a sensitivity of 87.09%, and a specificity of 66.67%. The AUCs for predicting AVF based on BMD and bone cement leakage were 0.712 and 0.735, respectively (P < 0.05).

Conclusion BMD and bone cement leakage are influencing factors for AVF after PKP in OVCF patients. Preoperative vertebral height loss rate has certain predictive value for AVF after PKP.