*Article* **Sarcopenia Is an Independent Risk Factor for Subsequent Osteoporotic Vertebral Fractures Following Percutaneous Cement Augmentation in Elderly Patients**

**Shira Lidar †, Khalil Salame †, Michelle Chua, Morsi Khashan, Dror Ofir, Alon Grundstein, Uri Hochberg, Zvi Lidar and Gilad J. Regev \***

> Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel

**\*** Correspondence: giladre@tlvmc.gov.il; Tel.: +972-3-697-4134

† These authors contributed equally to this work.

**Abstract: Introduction**: Subsequent osteoporotic vertebral fractures (SOVF) are a serious complication of osteoporosis that can lead to spinal deformity, chronic pain and disability. Several risk factors have been previously identified for developing SOVF. However, there are conflicting reports regarding the association between sarcopenia and multiple vertebral compression fractures. As such, the goal of this study was to investigate whether sarcopenia is an independent risk factor of SOVF. **Methods:** This was a retrospective case–control study of elderly patients who underwent percutaneous vertebral augmentation (PVA) due to a new osteoporotic vertebral compression fracture (OVCF). Collected data included: age, sex, BMI, steroid treatment, fracture level and type, presence of kyphosis at the level of the fracture and bone mineral density (BMD). Identification of SVOFs was based on clinical notes and imaging corroborating the presence of a new fracture. Sarcopenia was measured using the normalized psoas muscle total cross-sectional area (nCSA) at the L4 level. **Results:** Eighty-nine patients that underwent PVA were followed for a minimum of 24 months. Average age was 80.2 ± 7.1 years; 58 were female (65.2%) and 31 male (34.8%). Psoas muscle nCSA was significantly associated with age (*p* = 0.031) but not with gender (*p* = 0.129), corticosteroid treatment (*p* = 0.349), local kyphosis (*p* = 0.715), or BMD (*p* = 0.724). Sarcopenia was significantly associated with SOVF (*p* = 0.039) after controlling for age and gender. **Conclusions:** Psoas muscle nCSA can be used as a standalone diagnostic tool of sarcopenia in patients undergoing PVA. In patients undergoing PVA for OVCF, sarcopenia is an independent risk factor for SOVF.

**Keywords:** sarcopenia; osteoporosis; recurrent fractures; psoas; cross-sectional area
