Background <p>This study aims to explore the association between the baseline lipid levels of patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebroplasty (PVP) and the occurrence of re-fracture 12 months after the surgery. It also aims to identify the independent risk factors for re-fracture, providing a basis for the clinical formulation of targeted intervention strategies.</p> Methods <p>We retrospectively analysed the clinical data of 600 patients with OVCF treated with PVP between January 2018 and January 2023. All patients underwent PVP surgery and were followed up for 12 months after surgery. Patients with re-fracture within 12 months were divided into the re-fracture group, and those without re-fracture were divided into the control group, comparing the two groups in terms of age, gender, smoking history, bone mineral density (BMD), hypertension, diabetes mellitus, bone cement injection dose, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density and stability lipoprotein cholesterol (LDL-C). Univariate analysis, binary logistic regression, Cox proportional hazards regression and Kaplan-Meier survival analysis were used to explore the association between baseline lipid levels and postoperative re-fracture, and to identify independent risk factors.</p> Results <p>The overall re-fracture rate was 16.28%. There were no statistically significant differences between the groups for gender, smoking history, hypertension, diabetes mellitus, cement injection dose and HDL-C (<i>P</i> &gt; 0.05). Age, bone mineral density (BMD), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and sagittal stability were significantly different between the re-fracture and control groups (<i>P</i> &lt; 0.05). Binary logistic regression and Cox proportional hazards regression confirmed that advanced age, low TG, high LDL-C and sagittal imbalance were independent risk factors for re-fracture. Kaplan-Meier survival analysis showed that patients with combined low TG and high LDL-C had the lowest 12-month cumulative non-refracture survival rate (Log-rank test, <i>P</i> &lt; 0.001).</p> Conclusions <p>Baseline lipid levels (low TG, high LDL-C), advanced age and sagittal imbalance are independent risk factors for re-fracture after PVP in OVCF patients. These findings highlight the importance of regular lipid monitoring in elderly patients with osteoporosis and consideration of targeted therapeutic interventions when clinically indicated.</p>