Background: Athletes and fitness enthusiasts often encounter thoracolumbar compression fractures due to rigorous physical activities. Combining calcium (Ca) and zoledronic acid (ZOL) with percutaneous kyphoplasty (PKP) has shown promising clinical efficacy in elderly patients with osteoporotic thoracolumbar compression fractures (OTCF). However, the potential benefits of this approach in athletes and fitness enthusiasts require further investigation.

Methods: We conducted a retrospective analysis of 295 athletes and fitness enthusiasts (mean age 75.91±3.74 years) with OTCF who underwent PKP. Patients were divided into three groups: PKP+Ca (n=92), receiving 1500mg/d Ca carbonate post-surgery; PKP+ZOL (n=98), receiving 5mg ZOL intravenously post-surgery; and PKP+Ca+ZOL (n=105), administered with a combination of Ca and ZOL post-surgery. A two-year follow-up was conducted, and clinical and imaging data were recorded and analyzed before and after treatment.

Results: There were no significant differences in general information, lumbar bone mineral density (BMD), visual analog scale (VAS), Oswestry dysfunction index (ODI), and bone marker levels among the three groups before treatment. In the 3rd, 6th, 12th, and 24th months post-treatment, the PKP+Ca+ZOL group exhibited higher vertebral heights compared to the PKP+Ca and PKP+ZOL groups. Additionally, in the 6th, 12th, and 24th months post-treatment, the PKP+Ca+ZOL group demonstrated lower kyphosis than the PKP+Ca and PKP+ZOL groups. Furthermore, in the 12th and 24th months post-treatment, the PKP+Ca+ZOL group had higher BMD values than the PKP+ZOL and PKP+Ca groups. VAS scores in the PKP+Ca+ZOL and PKP+ZOL groups were significantly lower than those in the PKP+Ca group. ODI scores and bone marker concentrations were also lower in the PKP+Ca+ZOL group compared to the other groups. Importantly, the incidence of postoperative vertebral refracture was 1.02% in the PKP+ZOL group and 7.60% in the PKP+Ca group, while no refractures were observed in the PKP+Ca+ZOL group. The incidence of adverse reactions was similar between the PKP+ZOL (39.04%) and PKP+Ca+ZOL (34.69%) groups.

Conclusion: The combination of PKP and Ca and ZOL demonstrates a high clinical efficacy in the treatment of OTCF among athletes and fitness enthusiasts. This approach offers potential benefits for individuals engaged in rigorous physical activities and warrants further exploration.