Evaluating the Role of Sarcopenia in Long-Term Outcomes After Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures: Systematic Review and Meta-Analysis

Introduction: Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in older adults. Percutaneous kyphoplasty (PKP) is often used to relieve pain and restore mobility. However, some patients have suboptimal outcomes post-PKP, including residual pain and recurrent fractures. This study evaluates whether sarcopenia, an age-related syndrome of muscle loss, affects the long-term prognosis of OVCF patients undergoing PKP.

Methods: A systematic review and meta-analysis were performed. Searches of PubMed, Embase, and the Cochrane Library identified studies reporting both short- and long-term outcomes in sarcopenic and non-sarcopenic patients. Quality assessment followed PRISMA guidelines, and pooled estimates were calculated using random-effects models. Heterogeneity was quantified with I² statistics, while subgroup and sensitivity analyses explored sources of variation. Publication bias was evaluated using Egger’s test and funnel plots.

Results: Fifteen studies with 2,677 patients were included, comparing sarcopenic (n=760) and non-sarcopenic (n=1,917) groups. Baseline characteristics were similar (P > 0.05). Sarcopenic patients had longer times to ambulation (2.5 ± 1.3 vs. 1.8 ± 1.0 days, P = 0.01) and extended hospital stays (5.3 ± 2.7 vs. 4.1 ± 2.4 days, P = 0.03). Although both groups improved in Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores postoperatively, sarcopenic patients reported higher VAS scores (2.1 ± 0.7 vs. 1.5 ± 0.8 at 6 months, P < 0.01) and ODI scores (20.3 ± 4.5 vs. 13.6 ± 4.1 at 6 months, P < 0.01). Non-sarcopenic patients had higher MacNab excellent rates (73.2% vs. 52.4%, P < 0.01), while sarcopenic patients showed increased rates of residual pain (22.5% vs. 9.2%) and re-fractures (28.7% vs. 13.5%) (P < 0.01). Radiographic measures indicated better maintenance of kyphosis and vertebral height in non-sarcopenic patients at 12 months (P < 0.05). Publication bias was not significant (Egger’s test P = 0.12), and heterogeneity was low (I² = 20–35%).

Conclusion : Sarcopenia significantly worsens clinical and radiological outcomes post-PKP in OVCF patients. Sarcopenic patients face delayed recovery, increased pain, higher re-fracture rates, and less vertebral stability. These results emphasize the need for early sarcopenia detection and targeted interventions to improve long-term outcomes in this vulnerable population.