TITLE:
High-Viscosity versus Low-Viscosity Bone Cement in the Management of Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis
AUTHORS:
Ali Ahmed Mohamed, Xiaofang Zang, Yong Zhou, Jinsong Li, Ayub Abdulle Nur
KEYWORDS:
Osteoporotic Vertebral Compression Fracture, Bone Cement Viscosity, Vertebroplasty, Cement Leakage, Meta-Analysis
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.16 No.6,
June
30,
2026
ABSTRACT: Background: Clinical uncertainty persists regarding the optimal cement viscosity for vertebral augmentation in osteoporotic vertebral compression fractures (OVCFs). Objective: To compare the efficacy and safety of high-viscosity (HVC) versus low-viscosity (LVC) bone cement in percutaneous vertebroplasty for OVCFs. Methods: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) were searched from inception to April 15, 2026, without language restriction; however, only English and Chinese language publications were eligible. The primary outcome was cement leakage rate; secondary outcomes included pain (visual analog scale, VAS), functional disability (Oswestry Disability Index, ODI), vertebral height restoration, and complications. Random-effects meta-analysis was performed, with effect sizes expressed as odds ratios (ORs) or mean differences (MDs), along with 95% confidence intervals (CIs). Results: Four studies (1 RCT, 3 retrospective cohorts) comprising 218 patients (110 HVC, 108 LVC) with 235 treated vertebrae were included. In separate meta-analyses by unit of analysis, limited evidence suggested lower cement leakage with HVC: per-patient OR 0.19 (95% CI 0.09 - 0.40) and per-vertebra OR 0.22 (95% CI 0.08 - 0.63). No significant differences were observed between groups for final follow-up VAS scores (MD ?0.06, 95% CI ?0.19 to 0.07, p = 0.35; I2 = 0%) or ODI scores (MD ?0.28, 95% CI ?2.94 to 2.38, p = 0.84; I2 = 31%). Vertebral height restoration and complication rates were similar between groups, but these findings were based on sparse narrative data. Conclusion: Low-certainty evidence suggests that high-viscosity cement may reduce radiographic cement leakage compared with low-viscosity cement in PVP, but available data do not show superior pain relief or functional recovery. Because the evidence base is small and includes mixed study designs, conclusions should be interpreted cautiously. Large, adequately powered randomized controlled trials are needed.