Comparative Long-Term Outcomes of Vertebroplasty Versus Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Propensity-Matched Analysis

Introduction Vertebroplasty and kyphoplasty are widely performed for osteoporotic vertebral compression fractures (VCFs). The objective of this study was to compare long-term clinical outcomes between patients undergoing vertebroplasty and kyphoplasty for osteoporotic VCFs. Methods We used the TriNetX US Collaborative Research Platform to identify adults aged ≥50 years with osteoporotic VCFs treated with vertebroplasty or kyphoplasty between 2000 and 2025. Patients with malignancy were excluded. Cohorts were propensity-matched 1:1 (7,528 per cohort) on demographic, comorbidity, and bone health variables. Outcomes were assessed using International Classification of Diseases-10 (ICD-10) and Current Procedural Terminology (CPT) codes: subsequent fractures (one year), short-term neurologic/functional complications (one month), opioid prescriptions (one year), repeat augmentation (two years), and all-cause mortality (five years). Results Patients treated with kyphoplasty had a higher one-year risk of subsequent vertebral fractures compared with vertebroplasty (4,196 (55.7%) vs 3,905 (51.9%); HR 0.89; 95% CI 0.85-0.93; p < 0.001). Patients undergoing vertebroplasty experienced more short-term neurologic complications, including spinal cord compression (HR 1.19; 95% CI 1.08-1.31; p < 0.001), radiculopathy (HR 1.19; 95% CI 1.06-1.33; p = 0.004), and difficulty walking (HR 2.15; 95% CI 1.65-2.79; p < 0.001). The two-year risk of repeat vertebral augmentation did not differ meaningfully between procedures (1,111 (14.8%) vs 1,069 (14.2%); HR 1.00; 95% CI 0.90-1.10; p = 0.90). Five-year all-cause mortality was similar between vertebroplasty and kyphoplasty (HR 1.04; 95% CI 0.99-1.10; p = 0.13). Conclusion Vertebroplasty and kyphoplasty demonstrated comparable long-term survival and repeat procedure rates, but differed in specific risk profiles. Kyphoplasty carried a modestly higher risk of subsequent fractures, whereas vertebroplasty was associated with more short-term complications and earlier, more frequent opioid use. These findings should inform procedure selection in patients with osteoporotic VCFs.