Objective To analyze the influencing factors for adjacent vertebral compression fractures （AVCF） after percutaneous kyphoplasty （PKP） in patients with osteoporotic vertebral compression fractures （OVCF）， taking into account the sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features. Methods The research subjects were selected from OVCF patients admitted to the hospital between November 2020 and August 2023. A total of 240 cases were included， and their clinical data were retrospectively analyzed. All the patients underwent PKP surgery and were followed up for 2 years. Based on whether the selected patients experienced AVCF during the follow-up period， they were divided into the occurrence group （54 cases） and the non-occurrence group （186 cases）. The clinical data and spinal pelvic sagittal plane parameters of the two groups were compared， and the risk factors were analyzed by multivariate Logistic regression analysis. The predictive value of the regression equation was analyzed by receiver operating characteristic （ROC） curves. Results The proportions of patients with diabetes， Ⅱ/Ⅲ degree fracture compression， initial fracture site T₁₀-L₂， bone cement intervertebral disc leakage， multi-segment fracture， and intervertebral disc injury in the occurrence group were 53.70%， 62.96%， 72.22%， 40.74%， 44.44%， and 33.33%， respectively， which were higher than those of 24.19%， 47.31%， 45.70%， 13.44%， 19.35%， and 13.98% in the non-occurrence group. The recovery rate of vertebral body height was lower than that in the non-occurrence group， and the TK， SVA， and TPA were higher than those in the non-occurrence group （P < 0.05）. Diabetes （OR = 2.408）， Ⅱ/Ⅲ degree fracture compression （OR = 2.838）， bone cement disc leakage （OR = 1.547）， multi-level fracture （OR = 2.155）， disc injury （OR = 3.043）， elevated TK （OR = 2.081）， elevated SVA （OR = 2.298）， and elevated TPA （OR = 1.636） were independent risk factors for AVCF in OVCF patients after PKP （P < 0.05）. The increased vertebral height recovery rate （OR = 0.328） was an independent protective factor （P < 0.05）. A regression equation was constructed： logit （P） = -7.087 + diabetes × 0.879 + fracture compression degree × 1.043 + bone cement intervertebral disc leakage × 0.436 + multi-level fracture × 0.768 + intervertebral disc injury × 1.113 - vertebral height recovery rate × 1.114 + TK × 0.733 + SVA × 0.832 + TPA × 0.436. The construction of the Logistic multiple regression diagnostic regression equation is effective. The ROC curve shows that when logit （P） > 0.174， the area under the curve （AUC） value is 0.898， and the diagnostic sensitivity and specificity are 83.33% and 82.80%， respectively. Conclusions Diabetes， Ⅱ/Ⅲ degree fracture compression， bone cement disc leakage， multi-level fracture， disc injury， elevated TK， elevated SVA， and elevated TPA were identified as independent risk factors for AVCF in OVCF patients after PKP， the increased vertebral height recovery rate was an independent protective factor. The regression equation constructed exhibited a high predictive value.