Abstract: Objective To analyze the risk factors for refracture in elderly patients with osteoporotic spinal fractures after vertebral augmentation, and to construct a refracture risk prediction model and evaluate its predictive value.Methods A total of 91 elderly patients with osteoporotic spinal fractures who underwent vertebral augmentation in the Department of Orthopedics of our hospital from June 2022 to June 2024 were included.They were divided into the refracture group (n=21) and the non-refracture group (n=70) according to whether refracture occurred within 1 year after surgery.Univariate analysis was used to screen potential factors influencing refracture, followed by multivariate logistic regression analysis to identify independent risk factors and establish a prediction model.The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the model.Results Univariate analysis showed that the single-segment bone cement injection volume, incidence of bone cement leakage, and thoracic kyphosis angle (TK) in the refracture group were significantly higher than those in the non-refracture group, while the proportion of spongy bone cement distribution, bone mineral density (BMD), local kyphosis angle (LKA), pelvic incidence (PI), and sacral slope (SS) were significantly lower, with statistically significant differences (P<0.05).Multivariate Logistic regression analysis confirmed that decreased BMD (OR=0.011, 95%CI: 0-0.940), decreased LKA (OR=0.627, 95%CI: 0.415-0.949), increased TK (OR=1.554, 95%CI: 1.062-2.273), decreased PI (OR=0.655, 95%CI: 0.443-0.969), and decreased SS (OR=0.691, 95%CI: 0.496-0.962) were independent risk factors for postoperative refracture (P<0.05).The area under the ROC curve (AUC) of the prediction model constructed based on the above indicators was 0.978 (95%CI: 0.952-1.000), with a sensitivity of 90.5% and a specificity of 94.3%, indicating excellent predictive performance.Conclusion Decreased BMD, LKA, PI, SS and increased TK are the core independent risk factors for refracture in elderly patients with osteoporotic spinal fractures after vertebral augmentation.The prediction model constructed based on these indicators has outstanding predictive efficacy, which can be used clinically to formulate personalized intervention plans and thereby reduce the occurrence of refracture.

Key words: elderly patients, osteoporotic spinal fractures, vertebral augmentation, refracture, risk factors