53 - Percutaneous Vertebral Augmentation After Osteoporotic Vertebral Compression Fracture: A Retrospective Cohort Analysis of 27,912 Patients

Sunday, April 12, 2026

3:18 PM - 3:27 PM ET

Presenting Author(s)

ZH

Zain S. Hussain, MD

Medical Student
University of Medicine and Health Sciences, United States

Author/Co-author(s)

Talha Ayaz, MD

Radiology Resident (PGY-4)
University of Texas Medical Branch, United States
AH

Ali Harb, M.D.

Diagnostic Radiology Residency Program Director
Wayne State University School of Medicine Department of Radiology, United States
SA

Shayan Abdullah, MD

Orthopedic Surgery Resident Physician
Department of Orthopedic Surgery, University of Pennsylvania, United States
AS

Arsalan Saleem, MD

Program Director
UTMB Galveston, Diagnostic & Interventional Radiology, United States

Purpose: To evaluate outcomes associated with percutaneous vertebral augmentation (PVA) in older adults with osteoporotic vertebral compression fractures (VCF), following the introduction of the 2025 WISeR model by CMS.

Materials and Methods: We used a multicenter EHR network to identify adults ≥65 y with osteoporotic VCF. Exposure was PVA; comparator was no PVA. Propensity score matching was conducted for baseline covariates including age at index, sex, body mass index, bisphosphonate use, diabetes, hypertension, prior pain diagnoses, nicotine dependence/cigarette smoking status, and alcohol use. Outcomes included post-operative opioid use, pulmonary embolism, pneumonia, cardiopulmonary composite (PE+pneumonia), procedure-related events, vertebral osteomyelitis, repeat augmentation, and new skilled nursing facility (SNF) admission. We report relative risk (RR) and absolute risk difference (ARD) with 95% confidence intervals (CI) for 1-year and all-time windows.

Results: Median follow-up at 1 year was 365 days in both groups; all-time median follow-up was 814 vs 849 days (PVA vs no PVA). At 1-year (n=27,912): risks of post-operative opioid use was lower with PVA (21.7% vs 25.8%; RR 0.84 [0.71–1.00], ARD −4.14%); PE was similar (1.38% vs 1.21%; RR 1.14 [0.92–1.40], ARD +0.16%); pneumonia was similar (5.69% vs 5.75%; RR 0.99 [0.89–1.10], ARD −0.06%); cardiopulmonary composite was similar (6.58% vs 6.48%; RR 1.02 [0.92–1.12], ARD +0.10%); procedure-related events were rare (0.13% vs 0.09%; RR 1.50 [0.72–3.12], ARD +0.04%); vertebral osteomyelitis was rare (0.36% vs 0.42%; RR 0.86 [0.59–1.26], ARD −0.06%); new SNF was similar (1.28% vs 1.16%; RR 1.10 [0.89–1.37], ARD +0.12%). When evaluating all-time intervals, similar outcomes were observed.

Conclusion: In matched older adults with osteoporotic VCF, PVA is associated with lower opioid exposure at 1 year and all-time, no clinically meaningful differences in cardiopulmonary events, and very low absolute rates of procedural/infectious complications. These findings are timely as CMS’s 2025 WISeR policy advances prior authorization for PVA in select states.