Association of bone metabolic markers, bone mineral density and clinical characteristics with the occurrence of secondary fractures after PVP/PKP for osteoporotic thoracolumbar fractures: a study on logistic.

OBJECTIVE: To investigate the relationship between bone metabolism markers, bone mineral density (BMD), clinical characteristics, and the occurrence of secondary fractures after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic thoracolumbar fractures (OTF). METHODS: A retrospective study was conducted on 107 OTF patients treated in our hospital from May 2023 to May 2024. Patients were divided into secondary fracture and non-fracture groups. Standard univariate analysis, Pearson correlation, collinearity diagnostics, and multivariate logistic regression were performed to identify independent risk factors. A predictive nomogram was constructed and internally validated via bootstrap resampling. RESULTS: Significant differences were observed between the fracture and non-fracture groups regarding age, number of operated vertebrae, incidence of cement leakage, levels of type I collagen amino-terminal propeptide (PINP), levels of 25-hydroxyvitamin D (25(OH)D), and BMD (all P < 0.05). Pearson correlation analysis confirmed that all these indicators were strongly correlated with secondary fracture occurrence. Multivariate logistic regression confirmed all six variables as independent risk factors. The nomogram constructed from these factors demonstrated excellent discriminative performance, with an area under the curve (AUC) value of 0.975. The calibration curve indicated no significant difference between predicted and actual probabilities, demonstrating high predictive value. CONCLUSION: Age, number of operated vertebrae, cement leakage, PINP, 25(OH)D, and BMD are closely associated with and are independent risk factors for secondary fractures after PVP/PKP in OTF patients. The nomogram model based on these factors has high value. Screening high-risk populations using these indicators provides crucial theoretical guidance for the clinical prevention and treatment of secondary fractures.