Comparative study on the efficacy of menadione, zoledronic acid, and calcitriol in combination with PKP for the treatment of osteoporotic vertebral compression fractures in extremely elderly patients

This study compares the efficacy and safety of menadione and zoledronic acid, both used in conjunction with calcitriol, in patients with osteoporotic vertebral compression fractures following percutaneous kyphoplasty (PKP) in an extremely elderly population. Patients with osteoporotic vertebral compression fractures (OVCF) were assigned into 4 groups. The basic treatment group received PKP and calcitriol for osteoporosis treatment. Experimental group 1 received menadione capsules in addition to the control treatment; experimental group 2 received zoledronic acid; experimental group 3 received both menadione soft capsules and zoledronic acid. The outcomes were assessed at 3, 6, and 12 months postoperatively, measuring visual analog scale (VAS) scores, Oswestry disability index (ODI), bone mineral density, anterior vertebral height ratio, correction of Cobb angle, inflammatory markers, biochemical markers of bone turnover, risk of refracture, and adverse drug reactions. At 3, 6, and 12 months postoperatively, both VAS and ODI scores in experimental groups 1, 2, and 3 were significantly lower than baseline and the basic treatment group. However, group 3 showed significantly lower scores than both groups 1 and 2 (all P < .05). Bone mineral density in experimental groups 1, 2, and 3 increased significantly compared to baseline and was higher than the basic treatment group, with no significant difference between groups 1 and 2, but group 3 showed significantly higher values than both groups 1 and 2 (all P < .05). Levels of SVCAM-1, SICAM-1, UNTX, and SBAP in experimental groups 1, 2, and 3 decreased significantly at 3, 6, and 12 months post-treatment compared to baseline and the basic treatment group, with group 3 showing significantly lower levels than groups 1 and 2 (all P < .05). The refracture rates within 12 months were 10.00% (4/40), 7.50% (3/40), 7.50% (3/40), and 2.50% (1/40) for groups 1, 2, 3, and the basic treatment group, respectively, with no significant difference (P > .05). In extremely elderly patients with osteoporotic vertebral compression fractures, the combination of calcitriol with menadione soft capsules and zoledronic acid post-PKP significantly improves bone mineral density, promotes new bone formation, and effectively alleviates pain, with good short-term safety.