Table of Contents
This vertebral compression fracture guide introduces compression fractures and provides an understanding of the causes and treatments for these spinal fractures.
What is a Compression Fracture?
The American Association of Neurological Surgeons defines a vertebral compression fracture of the spine as a collapse, deformity, and/or loss of height of the vertebra. (1)
Causes of Vertebral Compression Fractures
Movements that flex our spine increase the compression fracture rate among women with low bone density, osteopenia, and osteoporosis. A sneeze or cough can be enough force to cause compression when someone has very fragile bones.
Repeated sit-ups and toe touches may lead to enough micro-trauma that a vertebral compression fracture occurs, even in people with denser bones.
Wedge Compression Fractures
A comparative study by Drs. Sinaki and Mikkelsen at the Mayo Clinic provided us with a much-needed understanding of the types of movements that cause wedge fractures. Wedge fractures are the most common type of compression fracture. (2)
Major osteoporosis fractures include compression fractures of the spine at any level. I explain in more detail how they occur in my video below.
Compression Fracture Symptoms
Many people with osteoporosis wonder if they are at risk of a vertebral fracture. The most recent US analysis to address this question came from data on 3,330 US adults aged 40 or older who participated in the National Health and Nutrition Examination Survey (NHANES) during the period between 2013 and 2014.
The prevalence of vertebral compression fractures in individuals under 60 was 4.7%. Between the ages of 70 and 79, the incidence rose to 11%, and in those 80 and older, it rose to 18%. Men and women were affected similarly. (3)
The following are major predictors of compression fractures. Either of these is a compression fracture risk factor.
- Over the age of 60.
- Had a previous fracture, however big or small.
- Back pain only lasts for a few weeks.
- Your back pain is “crushing” in nature.
- The back pain feels better when you lie down.
- You will most likely not have leg pain associated with your back pain.
- A historical height loss greater than 1.5 cm. (4)
Diagnosis, Prognosis, and Compression Fracture Treatment
Although spinal compression osteoporotic fractures, also known as vertebral compression fractures (VCFs), are the most common type of fracture that occurs as individuals age, they often go undiagnosed and untreated. (3)
When untreated, a single vertebral compression fracture can cause a gradual cascade of more vertebral compression fractures. These fractures can impact your quality of life, cause pain and disability, and limit your lifespan.
In my experience, patients diagnosed with an osteoporosis compression fracture of the spine do not realize they can do something to avoid further compression of the affected vertebra. To protect themselves, they must recognize the movements and positions that increase the chances that the vertebra will compress further. (5)
Once you have a single vertebral compression fracture, the compacted vertebra changes the forces above and below it. This places the neighbouring vertebrae at a higher risk of compression. The risk increases exponentially with each additional vertebral compression fracture.
Short Term Effects of a Spinal Compression Fracture
Before going into the potential consequences of a vertebral compression fracture, I want you to know that you can mitigate the impacts with appropriate intervention.
A vertebral compression fracture has an impact beyond the vertebra itself. It also affects the forces around the compression and the alignment of the entire spine.
Forces in the spine get altered once a vertebra gets compressed. These altered forces increase the probability of the vertebra above and below becoming compressed. Without intervention, the time lapse for a second compression is under six months.
What is the Treatment for Compression Fractures of the Spine?
Below are some of the treatment options to avoid your first or consecutive spinal fracture. These include conservative treatment and pharmaceutical intervention.
- Practice good posture at all times (and reduce the development of kyphosis).
- Practice good body mechanics with all daily activities.
- Strengthen back muscles.
- Regular exercise, including strength and balance training appropriate for your fracture risk.
- Minimize loaded spinal rotation and flexion.
- Pharmaceuticals (such as bisphosphonates) to reduce further bone loss.
- Healthy eating has not been studied, but we know it supports healthy bones.
Another option is either vertebroplasty or kyphoplasty where a special cement is injected into the bones of the spine. We discuss each of these modalities below.
Kyphosplasty for Compression Fracture
The literature on the short-term management of VCFs includes kyphoplasty and percutaneous vertebroplasty. (6) These techniques help to alleviate pain and correct alignment.
There are differences between both vertebroplasty and kyphoplasty (see illustration below) procedures, but their goal is similar: to restore the height of the compressed vertebra, taking pressure away from the nerve, thus reducing pain. The success rate for these two minimally invasive techniques is higher with kyphoplasties. (7)
The popularity of balloon kyphoplasties over vertebroplasties has risen, considering there are over 1.5 million VCFs yearly in the US alone. Despite the short-term pain relief, there is no long-term benefit to preventing further compression fractures. Due to the firmness of the cement polymer (bone cement) placed into the vertebra, the incidence of compression fractures around the restored vertebrae is 4.5 months. (7)
Data from the medical records of 507 patients with osteoporosis treated at the Mayo Clinic’s site in Rochester, MN, was collected and reviewed. The analysis was to compare the time-to-recurrence of compression fractures between three interventions. The three interventions were compared: vertebroplasty alone, plus back-extensor-strengthening, and back-extensor-strengthening alone. (8)
Below, you can see the time-lapse of a refracture based on each intervention:
- Vertebroplasty alone took 4.5 months
- Vertebroplasty plus Back-Extensor-Strengthening Exercises took 20.4 months
- Back-Extensor-Strengthening Exercises took 60.4 months.
Long Term Effects of a Spinal Compression Fracture
Unfortunately, the long-term consequences of multiple compression fractures are all too commonly considered signs of aging.
As we age, our fracture risk increases. Among Caucasian women over age 50, there is a 40% chance of experiencing a hip, spine, or vertebral fracture in their lifetime. (9)
Vertebral wedge fractures are the most common osteoporosis fracture type.
The name wedge fracture, refers to the wedge appearance of the vertebral body caused by the collapse of one side.
For individuals with scoliosis and osteoporosis, the consequences are more critical. The mechanical imbalance of the spine with scoliosis increases the risk for subsequent lumbar fractures. (10)
One of the most common consequences is more compression fractures. After two spinal compression fractures, the risk increases exponentially.
Fortunately, not everyone with a compression fracture has pain. (9)
Spinal or vertebral compression fractures can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, an increased risk of pressure sores, and psychological distress. (9)
My online course, Living with a Compression Fracture, is designed to help you manage your compression fracture.
Compression Fracture Pain Management
There is a wide variation in pain when it comes to vertebral compression fractures (VCFs).
Over 50% of individuals who have a vertebral compression fracture never have pain. Many who have pain will be fortunate to have the pain subside within 4 to 6 weeks. Yet, many people suffer in silence and do not get pain relief.
Many of my patients tell me they are worried that they may have had a vertebral compression fracture, but since it doesn’t hurt anymore, they feel relieved. “Surely, if my spine were fractured, it would still hurt!” Unfortunately, this is not the case.
Your primary care physician can help you with pain management for your compression fracture. He can prescribe the proper medication that helps with severe pain but does not increase your risk of falling.
Lingering Pain From Compression Fracture
If you have had lingering back pain from a compression fracture, please seek help. The faster you can get help to reduce pain, the less likely it is to become chronic.
Do I Have a Compression Fracture?
Discuss your concerns with your primary care physician so that they can request appropriate imaging of your spine.
If you have had a bone density test, the visual DEXA report can provide some information on the appearance of the lumbar (lower) spine, L1–L4. Ask to review the full DEXA report with the physician who ordered it. A DEXA image can provide information on the lumbar (lower) spine. Please note that Echolight scans do not provide an image of your spine. It is a generic image that you receive.
If you are having pain in your midback, be aware that the DEXA scan does not show anything above your lumbar spine.
For thoracic spine fractures, which are the most common type (2), your doctor will have to request different images.
Management of Vertebral Compression Fractures
I recommend the following after a compression fracture:
- Learn to move safely in all activities of daily living.
- Walk a few times a day. Start with just a few minutes every hour.
- Lie down to decompress your spine for a few minutes every few hours, ideally before your back gets too tired or is painful.
- Limit your sitting and avoid slouching.
- Modify your sports and hobbies to keep your spine safe and strong.
- Review the movements and exercises you should avoid for life.
- My Living with Compression Fracture course discusses everything from modifying sex, how to progress your exercises, what to do when you have a setback, and much more.
- Develop strong spinal muscles to protect your spine from further damage.
Compression Fracture Exercise and Stronger Spine
A 2022 study looking at osteoporotic vertebral compression fractures found that fatty degeneration of the paraspinal muscle was a predictive factor for progressive vertebral body collapse.
Lack of regular exercise for our spinal muscles increases the fat-to-muscle ratio. Fatty degeneration is associated with progressive weakening or collapsing of the spine. A study looking at osteoporotic vertebral compression fractures found that fatty degeneration of the paraspinal muscle was a predictive factor for progressive vertebral body collapse. (11)
I provide exercise recommendations for compression fractures in my course, Living with Compression Fractures.
- Viewed April 25, 2023. The American Association of Neurologic Surgeons. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures#:~:text=Vertebral+compression+fractures+(vertebral compression fractures)+occur,especially+in+the+lower+part.
- M Sinaki, B A Mikkelsen. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984 Oct;65(10):593-6.
- Cosman, F. et al. Spine Fracture Prevalence in US Women and Men Aged 40 years and older: Results from NHANES 2013-2014. Osteoporos Int. 2017 June ; 28(6): 1857–1866. doi:10.1007/s00198-017-3948-9.
- A retrospective observational study Medicine 100(1):p e24142, January 08, 2021.
- Bae, Jin Seok MD; Suh, InHyuk MD; Kim, Jong Keun MD; Jeong, Yong Sung MD; Lim, Jong Youb MD, PhD Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates
- Sujoy M, Yu-Po, L. Current concepts in the management of vertebral compression fractures. Oper Tech Orthop 2011; 21:251-260
- Daniela Alexandru, and William So. Evaluation and Management of Vertebral Compression Fractures. Perm J. 2012 Fall; 16(4): 46–51.
- Huntoon, E., Schmidt, C., Sinaki, M. Significantly Fewer Refractures After Vertebroplasty in Patients Who Engage in Back-Extensor-Strengthening Exercises January 2008 Mayo Clinic Proceedings 83(1):54-7
- Jason McCarthy, Amy Davis. Diagnosis and management of vertebral compression fractures. American family physician. 2016 Jul 1;94(1):44-50.
- Alex Sabo, Jesse Hatgis, Michelle Granville, and Robert E Jacobson Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus. 2017 Dec; 9(12): e1962
- Pongsthorn Chanplakorn, Thamrong Lertudomphonwanit, Nuttorn Daraphongsataporn, Chanika Sritara, Suphaneewan Jaovisidha, Paphon Sa-Ngasoongsong. Development of prediction model for osteoporotic vertebral compression fracture screening without using clinical risk factors, compared with FRAX and other previous models. Arch Osteoporos. 2021 Jun 3;16(1):84.
Ikchan Jeon, Sang Woo Kim, Dongwoo Yu. Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures. The Spine Journal Volume 22, Issue 2, February 2022, Pages 313-320