Objectives <p>By utilizing noninvasive data to analyze the risk factors for recurrent vertebral fractures in patients two years after vertebral augmentation and establishing a predictive model, the aim is to enhance the management of fragility fractures and reduce the incidence of postoperative recurrent fractures.</p> Methods <p>A total of 331 patients with osteoporotic fractures admitted to our hospital between January 2023 and December 2024 were selected as research subjects. The patients were divided into a refracture group (<i>n</i> = 85) and a non-fracture group (<i>n</i> = 246). The risk factors for osteoporotic fractures were analyzed using univariate analysis and multivariate logistic regression, and a prediction model was established based on the identified risk factors.</p> Results <p>Among 331 patients diagnosed with osteoporotic vertebral fractures, 85 experienced new fractures, accounting for 25.68% of all fractures. Multivariate logistic regression analysis indicated that smoking, alcohol consumption, falls, anti-osteoporosis treatment, and muscle fat infiltration were significant risk factors for postoperative refracture (<i>P</i> &lt; 0.05). The area under the receiver operating characteristic curve (AUC) for the combined predictors was 0.947 [0.92, 0.975]. The Hosmer–Lemeshow goodness-of-fit test applied to the model yielded a chi-square value of 9.532, with a p-value of 0.299 (<i>P</i> &gt; 0.05).</p> Conclusions <p>Smoking, alcohol consumption, falls, anti-osteoporosis treatment, and muscle fat infiltration are risk factors for recurrent vertebral fractures in patients within 2 years after vertebral augmentation. The construction of a prediction model can effectively predict the probability of postoperative recurrence of osteoporotic vertebral fractures and provide a reference for medical staff to identify high-risk patients with osteoporotic fractures and formulate effective intervention measures as soon as possible.</p> Clinical trial number <p>not applicable.</p>