Evaluating the Relationship Between Medical Management of Osteoporosis and the Rate of Recurrent Fractures Following Vertebral Augmentation: A Retrospective Cohort Study.

PURPOSE: To demonstrate the association between standard-of-care osteoporosis medical management (MM) following vertebral augmentation (VA) and the reduction in the incidence of additional osteoporotic vertebral compression fractures (OVCFs). MATERIALS AND METHODS: A single-center retrospective chart review was conducted on 249 patients who underwent VA for OVCFs between February 2019 and February 2024. Demographics, medical history, procedural data, and osteoporosis MM history were collected to evaluate the relationship of these variables to the incidence of additional OVCFs. RESULTS: Post-procedure, 33.3% of patients received MM, which was initiated at a mean of 6.09 months (SD = 6.31 months) following the index procedure. Multivariable logistic regression showed that within the population of patients studied, MM and age were the only patient or procedural factors significantly associated with refracture following VA. After matching MM and non-MM patients, the incidence rate of additional OVCFs after starting MM was 0.076 fractures per person-year, versus 0.519 fractures per person-year before or without MM (IRR = 6.79, 95 % CI: 3.37-15.51, p < 0.001). CONCLUSION: This analysis demonstrated that patients with OVCFs requiring VA who received MM for osteoporosis had a 6-fold decreased risk of OVCFs compared to those who did not receive MM, yet only 33.3% of patients were started on treatment at a mean of 6 months after the index procedure. This emphasizes the importance of adequate, timely osteoporosis management in patients after VA to prevent additional OVCFs.