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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors for thoracic-osteoporotic thoracic vertebral compression fractures during the normalized prevention and control period of COVID-19
Yi-Fan Li, Chen-Qiong Wu, Yang Long, Qi-Feng Yu, Wei Xu, Jian-Jie Zhao, Xiang-Yang Zhang, Zhi-Kun Li
Yi-Fan Li, Xiang-Yang Zhang, Department of Orthopedics, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
Chen-Qiong Wu, Qi-Feng Yu, Department of Spine, Shanghai General Hospital (Shanghai First People’s Hospital), Shanghai Jiao Tong University, Shanghai 200080, China
Yang Long, Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
Wei Xu, Zhi-Kun Li, Department of Spine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
Jian-Jie Zhao, Department of Sport Medicine, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou 341000, Jiangxi Province, China
Co-first authors: Yi-Fan Li and Chen-Qiong Wu.
Co-corresponding authors: Xiang-Yang Zhang and Zhi-Kun Li.
Author contributions: Li YF and Wu CQ wrote the article; Li YF, Zhang XY and Li ZK conducted the research design and they contributed equally to this manuscript as co-first authors; Zhao JJ, Zhang XY and Li ZK revised the article; Long Y and Yu QF collected the data; Xu W carried out statistical analysis; Zhang XY and Li ZK contributed equally to this manuscript as co-corresponding authors. All authors approved final revision of the paper.
Supported by the Shanghai Municipal Health Commission, No. 2022YQ006; and Master and Doctoral Innovation Base Project in Changning District, No. RCJD2022S02.
Institutional review board statement: This study was approved by the Ethics Committee of Tong Ren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (approval No. 2024-031).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data of this study has been run by the author for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhi-Kun Li, MD, PhD, Department of Spine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shang
hai 200080, China.
lizhikun@shsmu.edu.cn
Received: October 11, 2025
Revised: October 30, 2025
Accepted: December 8, 2025
Published online: February 18, 2026
Processing time: 123 Days and 19.8 Hours
BACKGROUND
Some scholars believe that there is a certain correlation between coronavirus disease 2019 (COVID-19) infection and the occurrence of osteoporotic vertebral compression fractures (OVCF), but no relevant domestic research reports have been published yet. This study retrospectively analyzed the clinical data of patients admitted for OVCF and treated with percutaneous vertebroplasty during the normalized prevention and control period of COVID-19 in Shanghai (after June 1, 2022), aiming to explore the individual differences of OVCF patients during this special period and analyze the risk factors for OVCF.
AIM
To explore risk factors for senile OVCF during COVID-19 normalization.
METHODS
Retrospective analysis of 230 OVCF patients (June 2022 to June 2023, percutaneous vertebroplasty, observation group) and 236 controls (June 2020 to June 2021, OVCF surgery). Observation group was split into nucleic acid-positive (n = 85) and negative (n = 145) subgroups. Fracture location/cause, visual analogue scale, activity scores were compared; risk factors identified.
RESULTS
Observation group had 42.2% thoracic fractures and 38.2% cough-induced fractures (both higher than controls, P < 0.05). No significant differences in post-op visual analogue scale (1 day, 1 month) or activity scores (P > 0.05). Nucleic acid results, fracture cause/location correlated (P < 0.05; cause-location r = 0.827). Logistic regression showed fracture cause, nucleic acid result, body mass index, bone mineral density as high-risk factors.
CONCLUSION
During COVID-19 normalization, cough is the top OVCF cause; thoracic fractures rise. The four factors above are independent risks. For elderly COVID-positive patients with recurrent cough, lung disease treatment, anti-osteoporosis therapy, and thoracic braces prevent thoracic OVCF.
Core Tip: During the normalized prevention and control period of coronavirus disease 2019 (COVID-19), compared with cases in the same period, cough is the main cause of osteoporotic vertebral compression fracture (OVCF), and most fractures are thoracic fractures. After percutaneous vertebroplasty treatment, the improvement of pain and function in patients is not significantly different from that in the same period. Regression analysis shows that cause of fracture, nucleic acid test result, body mass index, and bone mineral density are independent risk factors for thoracic OVCF. For elderly COVID-19-positive patients with recurrent cough, timely and active treatment of lung diseases, aggressive anti-osteoporosis therapy, and wearing a thoracic brace for protection are effective measures to prevent thoracic OVCF.
