Surgical management of osteoporotic vertebral fractures: current approaches. Literature review

Osteoporotic vertebral fractures represent one of the most prevalent and clinically significant complications of systemic osteoporosis, particularly in elderly patients. Reduced bone mineral density compromises the mechanical stability of spinal instrumentation and increases therisk of postoperative construct failure. This literature review analyzes studies retrieved from PubMed, Scopus, and Web of Science databases covering the period from January 2015 to April 2025. Included sources comprise original articles, randomized controlled trials, meta-analyses, and systematic reviews focused on the surgical treatment of osteoporotic vertebral fractures.The review summarizes contemporary surgical strategies aimed at improving fixation strength and optimizing clinical outcomes in patients with spinal osteoporotic lesions. Special attention is given to cement-augmented pedicle screws, expandable and fenestrated implants, cortical bone trajectory systems, as well as minimally invasive procedures such as vertebroplasty and kyphoplasty.Available evidence demonstrates that the use of bone cement significantly increases pedicle screw pullout strength and reduces the incidence of postoperative complications. Kyphoplasty additionally enables partial deformity correction and provides effective pain relief.The findings highlight the importance of an individualized approach to surgical planning, taking into account bone quality and anatomical characteristics of the affected segment. Such tailored strategies are critical to reducing the risk of revision surgeries and achieving stable, long-term functional outcomes.Keywords:оsteoporosis, pathological fracture, transpedicular fixation, cement augmentation,expandable screws, bicortical fixation, kyphosis, vertebroplasty, kyphoplasty.