Risk Factors and a Prediction Nomogram for Vertebral Fracture Cascade in Patients with Sarcopenia

This study aimed to identify risk factors and develop a predictive nomogram for vertebral fracture cascade (VFC) in patients with sarcopenia. A total of 889 patients with osteoporotic vertebral fractures were included, of whom 193 (21.7%) developed VFC. Univariate and multivariate logistic regression analyses identified advanced age, BMI ≥ 28 kg/m², history of steroid use, thoracolumbar fracture, shorter fracture-to-surgery interval, and sarcopenia as independent risk factors for VFC. A nomogram incorporating these variables was constructed and demonstrated good predictive performance, with area under the curve values of 0.778 in the training set and 0.710 in the validation set. Calibration and decision curve analyses confirmed the model’s accuracy and clinical utility. This nomogram provides a practical tool for early identification of high-risk patients, facilitating targeted interventions to prevent VFC in clinical practice.