Abstract: Objective To investigate the risk factors associated with the recurrence of adjacent vertebral fractures following percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF). 
Methods A total of 312 patients who underwent unilateral PVP surgery in the Third Hospital of Hebei Medical University were selected and divided into the normal group (n=269) and the vertebral refracture group (n=43) based on the recurrence of fractures postoperatively. Surgical and postoperative indicators of both groups were statistically analyzed; Postoperative indicators included gender, age, height, weight, residence (rural/urban), smoking, alcohol consumption, diabetes, hypertension, cardiovascular disease, and body mass index (BMI), and related surgical indicators included duration of operation, volume of bone cement injection, bone mineral density (BMD), postoperative vertebral compression rate, bone cement leakage, and postoperative Cobb angle. Continuous variables between the two groups were compared using t or U tests, and categorical variables were analyzed using chi-square tests. Predictors with significant differences in univariate analysis (P＜0.05) were included in multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curves were employed to determine the optimal cutoff values for statistically significant continuous variables (P＜0.05). 
Results During the 6-month follow-up period, 43 patients experienced refractures postoperatively, resulting in an incidence rate of 13.78%. Bone cement leakage occurred in 31 patients, with an incidence rate of 9.94%. Multivariate Logistic regression analysis indicated that BMD < -3.4 g/cm2 (OR=6.638, P=0.008), bone cement injection volume > 5.6 mL (OR=19.178, P＜0.001), postoperative Cobb angle > 14 ° (OR=18.970, P＜0.001), and bone cement leakage (OR=10.715, P=0.002) were associated with the recurrence of adjacent vertebral compression and were independent risk factors. The Hosmer-Lemeshow test demonstrated good model fit (χ2=4.07, P=0.254). 
Conclusion The incidence rate of vertebral refracture after PVP is 13.78%. BMD < -3.4 g/cm2, bone cement injection volume > 5.6 mL, postoperative Cobb angle >14 °, and bone cement leakage are independent risk factors for vertebral re-compression. Attention to the critical threshold of bone cement injection volume during surgery, reduction of the postoperative Cobb angle, and systematic anti-osteoporosis treatment can significantly decrease the incidence of refractures following vertebroplasty. 

Key words: osteoporotic fractures, recurrence, treatment outcome