Nomogram for predicting cemented vertebral refracture after percutaneous kyphoplasty in postmenopausal women with osteoporotic vertebral compression fractures

Objectives: This study aims to develop a nomogram model for predicting cemented vertebral refractures(CVFs) after percutaneous kyphoplasty(PKP) in postmenopausal women, providing guidance for clinical practice to reduce the incidence of such occurrences. Methods: The hospitalization records and outpatient follow-up data of patients with osteoporotic vertebral compression fractures(OVCFs) who underwent unilateral single-segment PKP at Department of Spine Surgery, Peking University People's Hospital, from April 2015 to July 2022, were collected. We utilized univariate analysis and binary logistic regression to identify the risk factors associated with CVF, and developed a nomogram model. The model was internally validated through 1000 resampling iterations using the bootstrap method. Results: 142 patients were involved, with the CVFs incidence rate of 14.08 % (20/142). Binary logistic regression showed that the CT value(OR0.954,95 %CI0.910-0.999), restoration of the Cobb angle(OR1.096,95 % CI1.051-1.143) and lack of postoperative anti-osteoporosis treatment(OR0.115,95 %CI0.018-0.755) are closely related to CVFs after PKP in postmenopausal women. The ROC curves indicate that the Nomogram exhibits a high level of accuracy, with the AUC for both the nomogram and the bootstrap-validated nomogram being 0.916 and 0.754, respectively. The Hosmer-Lemeshow goodness of fit test, calibration curves, DCA, and CIC demonstrated that the nomogram exhibits favorable predictive capabilities and clinical utility. Conclusion: The low CT value, high restoration of Cobb angle and lack of anti-osteoporosis treatment in postmenopausal women with OVCFs increase the risk of CVFs after PKP. The nomogram model developed in this study serves as an effective instrument for predicting CVFs in postmenopausal women.