Predictors of delayed union after surgical treatment in patients with osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

Abstract

The factors that predict delayed union in patients undergoing surgical management of osteoporotic vertebral compression fractures (OVCFs) have not been definitively established. This review aimed to comprehensively identify and analyze these factors to inform clinical practice and improve patient outcomes. Four English and three Chinese databases were systematically searched from inception to July 1, 2025. Stata 16.0 was utilized for data analysis. Predictors of delayed union reported in two or more studies were combined. Sensitivity analyses were performed to ensure stability and reliability. Egger and Begg's tests were applied to evaluate publication bias. This review included 14 studies with a total of 2,349 patients and found that the incidence of delayed union after surgical treatment in patients with OVCFs ranged from 7.86 to 50%. Twelve predictors associated with delayed union were included in this meta-analysis. Ten of them had a statistically significant effect on delayed union, covering baseline characteristics, biological and molecular factors, outcome measures, and therapeutic interventions. The most frequently reported predictor was high bone mineral density (OR = 0.173, 95% CI: 0.068 to 0.442, p < 0.001), followed by advanced age (OR = 1.122, 95% CI: 1.046 to 1.203, p < 0.001), combined diabetes (OR = 2.066, 95% CI: 1.697 to 2.514, p < 0.001), Bone Morphogenetic Protein-2/7 (OR = 0.890, 95% CI: 0.792 to 0.999, p = 0.048), and vertebral height restoration rate (OR = 1.848, 95% CI: 1.246-2.742, p = 0.002). A total of ten factors were identified as significant predictors of delayed union, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention. The findings of this study highlight the importance of comprehensive pre- and post- operative evaluations, along with careful surgical techniques, in reducing the risk of delayed union in patients with OVCFs.