title: Risk factors for new vertebral compression fractures after percutaneous vertebroplasty: qualitative evidence synthesized from a systematic review.
abstract: METHODS
  Methodological systematic review.
  
  
  OBJECTIVE
  To identify the risk factors for new vertebral compression fractures (VCFs) in patients after percutaneous vertebroplasty (PVP) and to grade the evidence according to the quality of included studies.
  
  
  BACKGROUND
  PVP is an effective procedure for the treatment of VCFs. A major concern after PVP in patients with osteoporosis is the occurrence of new VCFs in the untreated vertebrae. The risk factors for new VCFs after PVP reported thus far remain controversial. These risk factors have neither been well identified or summarized. This systematic review was performed to identify the risk factors for new VCFs after PVP.
  
  
  METHODS
  Noninterventional studies evaluating the risk factors for new VCFs of patients with osteoporosis after PVP were searched in MEDLINE, EMBASE, ScienceDirect, and OVID databases (all up to November 2012). Only observational studies with eligible data were included. Quality of included studies was assessed by a modified quality assessment tool, which was previously designed for observational study. The effects of studies were combined with the study quality score using a model of best-evidence synthesis.
  
  
  RESULTS
  Twenty-four observational studies involving 3789 patients were included. These articles were published between 2004 and 2012. According to the quality assessment criteria for included studies, 8 studies were deemed as high-quality studies, 6 as moderate-quality studies, and 10 as low-quality studies. There were strong evidences of 3 risk factors, including lower bone mineral density, lower body mass index, intradiscal cement leakage, and vertebral height restoration. We also identified 6 moderate-evidence factors including lower body mass index, number of pre-existing vertebral fractures, thoracolumbar junction in initial VCFs, cement distraction, older age, and number of treated vertebrae. Thirteen factors were classified into the limited-evidence risk factors.
  
  
  CONCLUSIONS
  Although there is no conclusive evidence for new VCFs of patients with osteoporosis after PVP procedure, these data provide evidence to guide the surgeon and develop optimal preventions for new VCFs after PVP. Special attention should be paid to the 3 strong-evidence risk factors. Further studies were still required to evaluate the effects of the earlier mentioned risk factors.
  
  
  METHODS
  2.
authors: *Department of Orthopaedics Institute, Tianjin Hospital, Hexi District, Tianjin, China; and †Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
authors: XinLong
authors: X
authors: Ma
authors: Dan
authors: D
authors: Xing
authors: JianXiong
authors: J
authors: Ma
authors: Jie
authors: J
authors: Wang
authors: Yang
authors: Y
authors: Chen
authors: WeiGuo
authors: W
authors: Xu
authors: Yang
authors: Y
authors: Yang
authors: BaoYi
authors: B
authors: Ma
authors: ShaoWen
authors: S
authors: Zhu
mesh_terms: D019317:Evidence-Based Medicine; D050815:Fractures, Compression / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects* / Q000379:methods