To evaluate the clinical efficacy of vertebroplasty combined with anti-osteoporosis drugs in the treatment of osteoporotic vertebral compression fractures in the middle-aged and elderly by meta-analysis.

According to the population, intervention, comparison, outcome and study design (PICOS) principle, the search strategy is formulated and implemented. Cochrane Library PubMed, Excerpta Medica Database (Embase), China National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database (VIP), Chinese BioMedical Literature Database (CBM) were searched for randomized controlled trials of vertebroplasty combined with anti osteoporotic drugs in the treatment of osteoporotic vertebral compression fractures in middle-aged and elderly patients. The time range of literature search was limited from January 2015 to January 2025, and meta-analysis, review, non randomized controlled trial research and animal experiments were removed. After evaluating the quality of the literature, and extracting the treatment outcome, visual analogue scale (VAS), bone mineral density (BMD), Barthel index score, Oswestry dysfunction index and other outcome indicators, Revman 5.3 and Stata 15.0 software were used for statistical analysis, and fixed effect or random effect models were used to evaluate the heterogeneity.

A total of 11 randomized controlled studies were included in this meta-analysis, including 953 patients, including 481 cases in the experimental group and 472 cases in the control group. The results of meta-analysis showed that the VAS score of vertebroplasty combined with drug therapy for osteoporosis group was lower than that of vertebroplasty alone group [mean difference (MD)=-1.37, 95%confidence interval (CI) (-1.42, -1.32), P<0.05]. BMD was higher in the vertebroplasty combined with drug therapy for osteoporosis group [MD=0.20, 95% CI (0.17, 0.23), P<0.05]. The treatment outcome of vertebroplasty combined with drug therapy for osteoporosis group was better [odds ratio (OR)=2.45, 95% CI (1.41, 4.24), P<0.05]. The Barthel index score was higher in the vertebroplasty combined with drug-therapy-for-osteoporosis group [MD=18.44, 95% CI (16.72, 20.15), P<0.05]. The Oswestry dysfunction index was lower in the vertebroplasty combined with drug therapy for osteoporosis group [MD=-8.38, 95% CI (-9.15, -7.61), P<0.05].

For middle-aged and elderly patients with osteoporotic fractures with vertebral crush injuries, vertebroplasty combined with drug therapy for osteoporosis, compared with vertebroplasty alone, has significantly reduced visual analog score, significantly improved bone mineral density, better treatment outcome, higher Barthel index score, and lower Oswestry dysfunction index. It is suggested that vertebroplasty combined with drug therapy for osteoporosis, should be promoted in the treatment of middle-aged and elderly patients with osteoporotic fractures with vertebral crush injuries.