AIM: Intercostal neuralgia is a clinically relevant complication after percutaneous vertebroplasty (PVP) in postmenopausal patients with osteoporotic vertebral compression fracture (OVCF), and its risk remains difficult to predict using conventional approaches. Perioperative serum markers are generally used as indicators of metabolic and nutritional status; however, their systematic association with the risk of post-PVP intercostal neuralgia has not been well established. This study aims to evaluate the predictive value of perioperative serological indicators and clinical factors for intercostal neuralgia after PVP in postmenopausal OVCF patients, to provide a reference for clinical risk stratification and individualized intervention.

METHODS: A total of 122 postmenopausal OVCF patients who underwent PVP from December 2023 to June 2025 were enrolled in this single-center retrospective cohort study. According to the occurrence of postoperative intercostal neuralgia, patients were divided into the intercostal neuralgia group (52 cases) and the non-intercostal neuralgia group (70 cases). Serum indexes were collected preoperatively and on postoperative day 1. Preoperative indicators included 25-hydroxyvitamin D (25(OH)D), alkaline phosphatase (ALP), serum calcium (Ca), and serum phosphorus (P). Postoperative indicators collected on postoperative day 1 included albumin (Alb) and fasting blood glucose (Glu). Univariate and multivariate logistic regression analyses were performed to identify independent predictors, and a combined predictive model was constructed. Model discrimination was assessed using the receiver operating characteristic (ROC) curve, while calibration was evaluated using a bootstrap method for assessing the model’s predictive consistency.

RESULTS: Multivariate logistic regression analysis showed that elevated postoperative Glu (odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.22–4.15) was an independent risk factor for postoperative intercostal neuralgia, while higher levels of postoperative albumin (OR = 0.90, 95% CI: 0.84–0.96), preoperative 25(OH)D (OR = 0.91, 95% CI: 0.85–0.98), and bone mineral density (BMD) T-score (OR = 0.18, 95% CI: 0.05–0.59) were protective factors. Fracture location (lower thoracic) was also independently associated with neuralgia risk (OR = 0.28, 95% CI: 0.11–0.73). The area under the receiver operating characteristic curve (AUC) of the combined predictive model constructed with these five indicators was 0.82 (95% CI: 0.75–0.89). The calibration curve demonstrated good agreement between predicted and observed risk (mean absolute error = 0.048), indicating satisfactory model discrimination and calibration.

CONCLUSIONS: BMD T-score, fracture location, postoperative Glu, postoperative Alb, and 25(OH)D can be used as independent predictors to predict intercostal neuralgia after PVP in postmenopausal OVCF patients. The combined model integrating BMD T-score, fracture location, postoperative Glu, postoperative Alb, and preoperative 25(OH)D demonstrates good predictive performance and may facilitate early risk stratification and individualized perioperative management of postoperative neuralgia.