Vertebral compression fracture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 4, 2016
StartDiseasesVertebral compression fracture

Compression fractures of the spine are breaks that occur in the vertebra of the back. The fractures are frequently related to osteoporosis, or thinning of the bone. Postmenopausal women over the age of 50 are most often affected. Nearly 25 percent of postmenopausal women have experienced a vertebral compression fracture

Contents

Definition & Facts

Compression fractures occur when a bone in the spine decreases in size due to cracking or breaking. It is a type of spinal fracture that can happen anywhere along the spine but most commonly occurs in the upper part of the back.

  • 'Wedge' fractures happen in the front of a vertebra, which then collapses its bony frontal area. The back of the bone remains stable, creating a vertebra that is then wedge-shaped, but unmovable, or stable.
  • 'Crush' vertebral fractures involve the fracture of the entire vertebrae, rather than just the front of the bone. Typically, these fractures maintain their stability, meaning that they don't worsen or change.
  • 'Burst' vertebral fractures are the most serious because the entire tube of the vertebra breaks down, resulting in significant loss of height and a bent posture with possible nerve and neurological damage. Bone fragments may spread to outside tissue.

Even though women are most affected by painful compression fractures, they occur in men as well. 

Symptoms & Complaints

Back pain is usually regarded as part of the normal process of aging, and a compression fracture may not be investigated properly and therefore left untreated. People with recurring back pain are often misdiagnosed as having muscle strain or tendon injury.

A vertebral fracture is a very painful break, and it is usually of sudden onset. Pain will occur when bending over or twisting. Walking or standing makes the discomfort worse. Lying supine if the fracture is in the lumbar vertebrae or lower region of the back may not produce as much pain as it does when the fracture is in the upper spine.

Sometimes, pain may radiate down a leg because nerves can be damaged through the break. At times, a compression fracture may cause no pain at all, but loss of height or mobility. The individual may assume a hunched position called kyphosis. Kyphosis is very serious, as the ribs and lungs are pushed forward and down by the collapsed spine, compromising oxygen intake and possibly heart function.

Chronic, low-level aching is common in the area where the fracture occurred, even after the healing process has completed. Healing sometimes results in structural changes to the back that result in chronic discomfort.

Causes

Osteoporosis is the major cause of spinal compression fractures. Osteoporosis is a progressive, silent disease, so most people do not know their bones are weakening. Usually, a fairly routine activity, such as picking up a suitcase, bending over and picking up an object from the floor or a misstep can cause the acute and sudden pain of a spinal compression fracture. 

Advanced osteoporosis is even more painful and breaks are frequent. A cough, sudden sneeze, stepping down a stairway or out of bed can result in a painful fracture that can take four to six weeks to heal.

Diagnosis & Tests

A physician will ask about the patient's history of back pain. Spinal fractures of the upper spine are usually extremely painful when a person lies supine, as it is thought that this position causes the cleft of the fracture to open. The doctor may ask the patient to lie supine during a physical examination and if he or she experiences pain while doing so, it often confirms suspicions of compression fracture. Those with fractures of the lower spine, due to thicker tissue in that area, are more likely to be able to lie flat without as much discomfort.

A spinal X-ray will be ordered to find out whether a vertebra has collapsed within the spinal column. A magnetic resonance imaging (MRI) test is also ordered because the scan will show details of nerves and intervertebral discs that could be involved with the trauma of the original fracture. Unless an MRI is performed, it is not possible to determine whether pain is caused by a recent fracture or a chronically painful, healed fracture. 

A bone biopsy may be performed because cancer causes a small percentage of compression fractures.

Treatment & Therapy

Conservative management of the fracture will be the first-line therapy. According to the American College of Radiology (ACR) the pain from compression fractures often eventually resolves itself without medical treatment. 

Physical therapy, massage, heat therapy, patch medications for analgesia, and bed rest can be effective. Bed rest needs to be of short duration with frequent rising or osteopenia and muscle wasting can occur. A thromboembolic event or blood clot is another complication of too much bed rest.

As soon as the individual becomes able to stand and walk, an exercise program should be in place. Walking should be increased as the person finds it bearable, until goals for distance can be set. Walking increases bone density in the legs, and is an essential feature of bone maintenance to prevent progression of osteoporosis. If loss of balance occurs, programs like Tai Chi are very effective as a means of fall prevention. 

Prevention & Prophylaxis

Prevention is the best approach to spinal compression fractures. Avoiding osteoporosis begins at a young age. Proper exercise and nutrition are essential for building strong bones that last a lifetime. 

Smoking and drinking too much alcohol contribute to thinning of the bone, particularly in women. Quitting smoking is vitally important to bone health. Adhering to weight-bearing exercise programs can help build bone density.

Calcium supplementation and getting vitamin D through supplements and outside sun exposure increase bone density. A daily regimen of about 1200 milligrams of calcium, ideally ingested through food rather than via supplements, are recommended for women between the ages of 50 to 70 according to the Cleveland Clinic. Hormone replacement therapy has a beneficial effect on bone strength for both men and women.

Drugs such as risedronic acid and alendronic acid can retard bone loss and build density, thereby preventing painful fractures. An injectable synthetic hormone teriparatide stimulates the growth of bone for those with severe osteoporosis. Zoledronic acid is another drug that can increase bone density, particularly in the spine, hip, wrist, arm, leg, and ribs. All of the bone building medications have rare side effects which must be examined before the medications can be prescribed.