Compression fractures of the back

  • Definition
    • Compression fractures of the back are broken vertebrae. Vertebrae are the bones of the spine.

  • Alternative Names
    • Vertebral compression fractures

  • Causes
    • Osteoporosis is the most common cause of this type of fracture. Osteoporosis is a disease in which bones become fragile. In most cases, bone loses calcium and other minerals with age.

      • Trauma to the back
      • Tumors that started in the bone or spread to the bone from elsewhere
      • Tumors that start in the spine, such as multiple myeloma

      Having many fractures of the vertebrae can lead to kyphosis. This is a hump-like curvature of the spine.

  • Symptoms
    • Compression fractures can occur suddenly. This can cause severe back pain.

      • The pain is most commonly felt in the middle or lower spine. It can also be felt on the sides or in the front of the spine.
      • The pain is sharp and "knife-like." Pain can be disabling, and take weeks to months to go away.

      Compression fractures due to osteoporosis may cause no symptoms at first. Often, they are discovered when x-rays of the spine are done for other reasons. Over time, the following symptoms may occur:

      • Back pain that starts slowly, and gets worse with walking, but is not felt when resting
      • Loss of height, as much as 6 inches (15 centimeters) over time
      • Stooped-over posture, or kyphosis, also called a dowager's hump

      Pressure on the spinal cord from hunched over posture can, in rare cases, cause:

  • Exams and Tests
    • Your health care provider will perform a physical exam. This may show:

      • A humpback, or kyphosis
      • Tenderness over the affected spinal bone or bones

      A spine x-ray shows at least 1 compressed vertebra that is shorter than the other vertebrae.

      Other tests that may be done:

      • A bone density test to evaluate for osteoporosis
      • A CT or MRI scan, if there is a concern that the fracture was caused by a tumor or severe trauma (such as a fall or car accident)
  • Treatment
    • Most compression fractures are seen in older people with osteoporosis. These fractures often do not cause injury to the spinal cord. The condition is usually treated with medicines and calcium supplements to prevent further fractures.

      Pain may be treated with:

      • Pain medicine
      • Bed rest

      Other treatments may include:

      • Back braces, but these may further weaken the bones and increase the risk of more fractures
      • Physical therapy to improve movement and strength around the spine
      • A medicine called calcitonin to help relieve bone pain

      Surgery may be done if you have severe and disabling pain for more than 2 months that does not get better with other treatments. Surgery can include:

      Other surgery may be done to remove bone if the fracture is due to a tumor.

      After surgery you may need:

      • A brace for 6 to 10 weeks if the fracture was due to an injury
      • More surgery to join spine bones together or to relieve pressure on a nerve
  • Outlook (Prognosis)
    • Most compression fractures due to injury heal in 8 to 10 weeks with rest, wearing of a brace, and pain medicines. However, recovery can take much longer if surgery was done.

      Fractures due to osteoporosis often become less painful with rest and pain medicines. Some fractures, though, can lead to long-term (chronic) pain and disability.

      Medicines to treat osteoporosis can help prevent future fractures. However, medicines cannot reverse damage that has already occurred.

      For compression fractures caused by tumors, the outcome depends on the type of tumor involved. Tumors that involve the spine include:

      • Breast cancer
      • Lung cancer
      • Lymphoma
      • Prostate cancer
  • Possible Complications
    • Complications may include:

      • Failure of the bones to fuse after surgery
      • Humpback
      • Spinal cord or nerve root compression
  • When to Contact a Medical Professional
    • Call your provider if:

      • You have back pain and you think you may have a compression fracture.
      • Your symptoms are getting worse, or you have problems controlling your bladder and bowel function.
  • Prevention
    • Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss.

  • References
    • Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-81. PMID: 25182228

      Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085-92. PMID: 20701962

      National Osteoporosis Foundation. 2014 Clinician's Guide to Prevention and Treatment of Osteoporosis. 2014. Accessed December 16, 2016.

      Savage JW, Anderson PA. Osteoporotic spinal fractures. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 37.

      Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016-24. PMID: 19246088