World Neurosurgery · Nov 4, 2026

Dementia Risk After Vertebral Augmentation for Osteoporotic Vertebral Compression Fracture: A Propensity Score-Matched Cohort Study

By Chen CM, Chang Y, Lin HM

Background Osteoporotic vertebral compression fractures (VCFs) cause chronic pain and prolonged immobility, both potentially modifiable risk factors for dementia. Vertebral augmentation (VA), performed as percutaneous vertebroplasty or balloon kyphoplasty, relieves pain and enables earlier mobilization. We examined whether VA is associated with a lower long-term risk of dementia than conservative management. Methods Using the TriNetX Global Collaborative Network, we conducted a retrospective, propensity score-matched cohort study of patients older than 60 years with a newly diagnosed VCF. Patients were grouped by receipt of VA within six months of diagnosis. After 1:1 propensity score matching on demographic, comorbidity, and osteoporosis-medication variables, we assessed incident dementia over five years using odds ratios (ORs) with 95% confidence intervals (CIs) and Kaplan-Meier curves with the log-rank test. A six-month landmark analysis was performed to limit immortal-time bias. Results Matching produced 3,830 patients per group, with every standardized mean difference below 0.1. Dementia occurred in 8.1% of the VA group and 9.9% of the non-VA group over five years (OR 0.80, 95% CI 0.68-0.94; absolute risk difference 1.8 percentage points). The association persisted in the six-month landmark analysis (3,497 patients per group; 6.2% vs 7.5%; OR 0.81, 95% CI 0.67-0.98). Conclusions In older adults with osteoporotic VCF, vertebral augmentation was associated with a lower medium-term incidence of dementia than conservative management. Given the observational design, unmeasured confounding, and competing mortality, this association is preliminary and hypothesis-generating, and requires confirmation in prospective studies before any causal inference or change in practice.

doi.org/10.1016/j.wneu.2026.125490 Open access PubMed 42982275 Populations