sRecent innovations in the management and augmentation of osteoporotic vertebral compression fractures: A narrative review

Osteoporotic vertebral compression fractures (OVCFs) are a major source of morbidity in patients with osteoporosis. Vertebral augmentation procedures (VAPs), including vertebroplasty and kyphoplasty, provide effective pain relief and stabilization when conservative management fails, but carry risks such as cement leakage, adjacent vertebral fractures, recollapse, and radiation exposure. This narrative review summarizes recent innovations intended to improve the safety, precision, and outcomes of VAPs, based on a non-systematic search of PubMed/MEDLINE, Embase, and Google Scholar for articles published between January 2010 and December 2025. The technologies are organized according to the clinical workflow of OVCF treatment, and the maturity of the supporting evidence is graded. Artificial intelligence and radiomics may improve risk stratification by predicting cement leakage, recollapse, adjacent fractures, and residual back pain, although most models are retrospective and internally validated. Finite element analysis supports planning of cement volume, distribution, and height restoration, but remains largely computational. Augmented reality and robotic platforms may improve puncture accuracy and reduce radiation exposure, at the cost of a learning curve and high expense. Remote-controlled injection of high-viscosity cement may limit leakage and operator exposure. Expandable implants may improve height maintenance, whereas bioactive cements remain mostly preclinical. Early anabolic therapy complements augmentation by reducing subsequent fractures. Overall, these technologies are complementary, but the evidence supporting them varies considerably, and multicenter prospective studies with standardized outcomes and long-term follow-up are needed before their routine clinical adoption.