Osteoporotic Vertebral Compression Fracture

What it is

A vertebral compression fracture is a break in which the front of a spine bone collapses and wedges down. In osteoporosis, the bone has weakened enough that this can happen with very little force — a minor fall, a lift, a hard cough, or sometimes nothing obvious at all. These are among the most common fractures in older adults, particularly women after menopause.

What it feels like

Often there is sudden back pain at the level of the break, worse with standing, walking, or changing position and better lying down. Some fractures cause little pain and are found later as a gradual loss of height or a more rounded upper back. Most do not cause nerve symptoms, because the back of the bone usually stays intact.

How we diagnose it

X-rays show the wedged bone, and an MRI can tell whether a fracture is recent and still healing — useful when there are several old changes and we need to know which one is causing your pain. I also look at this as a window into your bone health, because the fracture is often the first clear sign of significant osteoporosis.

How we treat it

Most compression fractures heal without surgery. Treatment focuses on controlling pain, staying as active as comfort allows, a brace for support if helpful, and — just as importantly — treating the underlying osteoporosis with bone-strengthening medication, vitamin D and calcium, and fall prevention. For pain that will not settle, a minimally invasive cement procedure (kyphoplasty) can stabilize the bone and relieve pain. Surgery beyond that is rarely needed.

The science — for the curious

The fracture in front of you is also a warning about the next one: once osteoporosis has caused one vertebral fracture, the risk of another rises substantially. That is why I treat the bone as seriously as the break — strengthening it is the single best thing we can do to prevent the cascade of fractures that osteoporosis otherwise tends to cause. Healing the painful fracture and protecting your future bone health go hand in hand.

Learn more

OrthoInfo — Osteoporosis and Spinal Fractures: orthoinfo.aaos.org

OrthoInfo — Fractures of the Thoracic and Lumbar Spine: orthoinfo.aaos.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.