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Objective.To identify the risk factors for new vertebral compression fractures (VCFs) in patients after percutaneous vertebroplasty (PVP) and to grade the evidence according to the quality of included studies.Background.PVP is an effective procedure for the treatment of VCFs.A major concern after PVP in patients with osteoporosis is the occurrence of new VCFs in the untreated vertebrae.The risk factors for new VCFs after PVP reported thus far remain controversial.These risk factors have neither been well identified or summarised.The present systematic review was performed to identify the risk factors for new VCFs after PVP.Methods.Non-interventional studies evaluating the risk factors for new VCFs of patients with osteoporosis after PVP were searched in Medline,Embase,Sciencedirect and OVID database (all to Nov 2012).Only observational studies with eligible data were included.Quality of included studies was assessed by a modified quality assessment tool,which was previously designed for observational study.The effects of studies were combined with the study quality score using a model of best-evidence synthesis.Results.24 observational studies involving 3789 patients were included.These articles published between 2004 and 2012.According to the quality assessment criteria for included studies,8 studies were deemed as high quality studies,6 as moderate quality studies,and 10 as low quality studies.There were strong evidence for 3 risk factors,including lower BMD,lower BMI,intradiscal cement leakage,and vertebral height restoration.We also identified 6 moderate-evidence factors including lower BMI,number of preexisting vertebral fractures,thoracolumbar junction in initial VCFs,cement distraction,older age,and number of treated vertebrae.Thirteen factors were classified into the limited evidence risk factors.Conclusion.Whilst there is no conclusive evidence for new VCFs of patients with osteoporosis after PVP procedure,these data provide evidence to guide the surgeon and develop optimal preventions for new VCFs after PVP.Special attention should be paid to the 3 strong-evidence risk factors.Further studies were still required to evaluate the effects of all above risk factors.