Spinal compression fracture and osteoporosis

A compression fracture is a break in a vertebra in which the bone collapses and loses height, often taking on a wedge shape. Most occur in bones weakened by osteoporosis, sometimes from minor strain such as bending, lifting, or even coughing. A compression fracture can be the first sign that bones have become fragile.

• Sudden back pain, most often in the mid or lower back
• Pain that worsens with standing, walking, or bending and eases when lying down
• Loss of height
• A gradually rounded or stooped upper back (kyphosis)
• Less often, numbness, tingling, or weakness in the legs if the fracture affects the nerves

Some compression fractures cause little or no pain and are found by chance on an X-ray.

Osteoporosis, in which bones lose density and strength, is the most common cause. Weakened vertebrae can break with everyday movements or a simple fall. High-energy trauma, such as a car crash or a fall from a height, can cause compression fractures in healthy bone. Less commonly, cancer that has spread to the spine or a cancer of the bone marrow such as multiple myeloma weakens a vertebra.

Risk factors for osteoporosis and fragility fractures include:

• Older age, especially in women after menopause
• A previous fracture from a minor fall
• A family history of osteoporosis or hip fracture
• Long-term use of certain medications, such as steroids
• Smoking, heavy alcohol use, and low physical activity
• Low calcium and vitamin D intake

A clinician examines your back for tenderness, posture, and height loss and checks nerve function in the legs. X-rays usually show the fracture. An MRI can show whether a fracture is new or old and whether the nerves are affected, and a CT scan gives more bone detail.

A bone density (DXA) scan measures bone strength to diagnose osteoporosis and guide treatment to lower the chance of future fractures. When a fracture happens without a clear reason, further tests may look for other causes.

Most compression fractures heal without surgery. Non-surgical care includes pain medication, a short period of reduced activity followed by a gradual return to walking, and sometimes a back brace for comfort. Physical therapy helps with posture, core strength, and balance.

Treating the underlying osteoporosis is a key part of care. Someone who has had one fragility fracture is at higher risk of more fractures of the spine, hip, or wrist, so your clinician may recommend calcium and vitamin D, exercise, fall prevention, and bone-strengthening medication.

For a recent fracture with severe pain that does not improve with non-surgical care, a minimally invasive procedure may be discussed. In vertebroplasty, bone cement is injected into the broken vertebra; in kyphoplasty, a small balloon first creates space before the cement is placed. Experts differ on which patients benefit, so these procedures are individualized. Open surgery is uncommon and is generally reserved for fractures that press on the nerves or make the spine unstable.

Pain from an osteoporotic compression fracture usually eases gradually as the bone heals, though some people have lasting back pain. The vertebra typically heals in its compressed shape, so lost height does not return. Staying as active as comfort allows, with guidance from physical therapy, helps protect muscle strength and bone health during recovery.

• Ask your clinician about bone density screening, which is recommended for women 65 and older and for younger people with risk factors
• Get enough calcium and vitamin D through diet, or supplements as advised
• Do regular weight-bearing and muscle-strengthening exercise, such as walking and resistance training
• Reduce fall risk: improve home lighting, remove tripping hazards, and review medications that cause dizziness
• Don't smoke, and limit alcohol
• If you have osteoporosis, take bone medications as prescribed