Association between platelet to lymphocyte ratio and the risk of vertebral fracture in patients with osteoporosis: a systematic review and meta-analysis
Abstract
Background: Vertebral fractures, accounting for 40% of osteoporotic fractures, often lack early clinical symptoms, necessitating improved risk prediction biomarkers. This meta-analysis was the first to evaluate the association between platelet-to-lymphocyte ratio (PLR) and vertebral fracture risk in osteoporosis patients.
Methods: We systematically searched PubMed, Embase, Web of Science, Cochrane, Wanfang and CNKI (up to July 2025). Odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were used for the data synthesis of categorical and continuous variables, respectively. Sensitivity analysis was performed to explore the stability of the results and potential sources of heterogeneity. All analyses were performed using Review Manager 5.4 and STATA 15.0.
Results: Seven observational studies were included. Categorical data showed significantly higher vertebral fracture risk in high-PLR groups (OR: 1.02; 95% CI: 1.00, 1.03; P = 0.01). Continuous data revealed a significantly higher PLR level in the fracture group compared with the non-fracture group (SMD: 1.78; 95% CI: 0.32, 3.25; P = 0.02). No significant publication bias was detected for either categorical or continuous variables. Sensitivity analyses revealed instability in both categorical and continuous outcomes and found that the Di et al., 2024 and Song et al., 2022-II studies might be the main sources of heterogeneity.
Conclusion: Elevated PLR is associated with increased vertebral…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.