Association between platelet to lymphocyte ratio and the risk of vertebral fracture in patients with osteoporosis: a systematic review and meta-analysis

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

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

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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