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

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.