ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1664157
This article is part of the Research TopicAddressing Fracture Risk in Aging Populations: Integrated Prevention TacticsView all 9 articles
Predicting re-fracture risk factors in elderly osteoporotic vertebral fractures patients with comorbidities: development and validation of nomogram
Provisionally accepted
- 1Affiliated Hospital of Jining Medical University, Jining, China
- 2China Medical University, Shenyang, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Osteoporotic vertebral compression fractures (OVCFs) pose a significant health burden in elderly populations, with postoperative re-fracture (re.fra) complicating recovery. Existing models (e.g., FRAX, QFracture) inadequately address comorbidities and modifiable lifestyle factors. This study aimed to develop and validate a novel nomogram integrating these underrecognized yet critical predictors for personalized risk stratification. Methods: A retrospective cohort of 560 elderly OVCF patients undergoing percutaneous vertebroplasty (PVP) was analyzed. Patients were randomly divided into training (70%, n=392) and testing (30%, n=168) cohorts. Univariable and backward stepwise multivariable logistic regression identified independent re.fra predictors. A nomogram was developed and internally validated using area under the curve (AUC), calibration curves (slopes, intercepts), Brier scores, and decision curve analysis (DCA) to assess discrimination, calibration, and clinical utility. Results: Independent predictors included tumor history (adjusted odds ratio (aOR)=12.29, 95% CI:2.50–60.35), scoliosis (aOR=6.46, 95% CI:2.97–14.03), mental disorders (aOR=5.91, 95% CI: 2.73–12.82), alcohol use ≥10 years (aOR=3.69, 95% CI:1.90–7.17), and chronic kidney disease (aOR=3.12, 95% CI:1.61–6.06). Hypertension exhibited a paradoxical protective association (aOR=0.50, 95% CI:0.27–0.93). The nomogram demonstrated strong discrimination (AUC:0.886 (training), 0.827 (testing)), excellent calibration in training (slope=1.000, Brier=0.118) with slight deviation in testing (slope=0.697, Brier=0.162), and superior net benefit over treat-all/none strategies across thresholds (DCA). Conclusion: This validated nomogram integrates often-overlooked comorbidities and lifestyle factors to predict post-PVP re.fra risk, providing a practical tool for personalized management and highlighting the need for multidisciplinary care in high-risk subgroups such as those
Keywords: OVCF, Refracture, risk factor, nomogram, PVP
Received: 03 Oct 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 Qi, Wu, Chen, Zhang, Meng, Wei, Wang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chunyang Meng, mengchunyang1600@mail.jnmc.edu.cn
Hong Wang, wanghongspine@126.com
Qingwei Li, plasurg0618@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.