Vertebral compression fractures are fractures involving the vertebral bodies that make up the spinal column. In vertebral compression fractures (VCF), the body collapses and compresses into itself, producing a “wedged” vertebra. These compression fractures may involve the collapse of one or more vertebrae in the spine, typically due to osteoporosis or cancer that weakens the bones. But they can also happen after trauma (such as a car crash) or as a result of tumors on the spine.
Compression fractures usually happen in the thoracic (middle) part of the spine, especially in the lower thoracic area. Vertebral compression fractures can cause severe back pain leading to inability to perform daily activities, and in some cases, a kyphotic (hunched-over) deformity.
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Vertebral compression fractures are quite common – nearly 1 million happen each year in the United States. They are most common in older, post-menopausal women with osteoporosis (a reduction in bone density that causes bones to become weak and brittle). It is estimated that 1 in 4 women over 50 years old have at least one compression fracture. However, they also occur in older men, and nearly 50% of people over the age of 80 have had a compression fracture.
Symptoms of Vertebral Compression Fractures (VCF)
Compression fracture symptoms range from mild to severe. Some people may not experience any symptoms and only discover the fracture when they have an X-ray performed for a different condition. However, many people with compression fractures cannot stand or walk without experiencing pain.
The symptoms of a fractured spine can include:
- Back pain
- Reduced mobility or flexibility in the spine. It may be difficult for you to twist or bend over.
- Kyphosis – a curve in the back that creates a “hunched over” appearance (also called a hunchback)
- Loss of height as the vertebrae compress and the back curves.
- Tingling and numbness in the back from pinched nerves and nerve damage.
- Difficulty controlling the bladder or bowels
Diagnosing Vertebral Compression Fractures
To diagnose a compression fracture, your provider will examine you and ask about your symptoms. During the exam, your provider will:
- Check your spine’s alignment and your posture.
- Lightly press on different areas of your back to identify the area of pain.
- Look for signs of nerve damage including numbness, tingling or muscle weakness.
- Order imaging studies such as: CT scan, spine X-ray or MRI
Treatment for Vertebral Compression Fractures
Compression fracture treatment focuses on relieving pain, stabilizing the bones in the spine and preventing further fracturing. Depending on the severity of the fracture and your overall health, initial treatment may include:
- Pain relief medication: Your provider may recommend over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen sodium.
- Back Brace: designed to support your vertebrae, relieve pressure on injured muscles, and limit your range of motion
- Bone-strengthening medications: A type of drugs called bisphosphonates can slow the progression of bone loss and help prevent fractures. Examples include ibandronic acid (Boniva®) and alendronic acid (Fosamax®), and Risedronate (Actonel®).
If these treatments have not proven effective, your doctor may recommend a vertebroplasty or kyphoplasty procedure, a minimally invasive procedure designed to treat painful vertebral compression fractures. In vertebroplasty, physicians use image guidance, typically fluoroscopy, to inject a cement mixture into the fractured bone through a hollow needle. During kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.
These procedures are generally reserved for people with severe back pain caused by vertebral compression fractures. Vertebroplasty and kyphoplasty are typically recommended only after less invasive treatments, such as rest, a back brace, or pain medication, have proven ineffective. However, the procedures can be performed immediately in patients with problematic pain requiring hospitalization or for conditions that limit bed rest and pain medications. Vertebroplasty and kyphoplasty should be completed within eight weeks of the acute fracture for the highest probability of successful treatment.
Preventing Compression Fractures
Although you may not be able to 100% prevent compression fractures, you can reduce your risk of a compression fracture from osteoporosis by doing the following:
- Do not drink alcohol to excess.
- Eat a healthy diet that provides enough of the vitamin D and calcium that strengthen your bones.
- Quit smoking and using tobacco. Nicotine weakens bones and can cause cancer.
- Get regular checkups with your doctor, and continue taking bone-strengthening medications as prescribed.
When Should I See a Doctor?
If you are experiencing sudden back pain that doesn’t resolve after a couple of days, contact your doctor so they can determine the cause and recommend a course of treatment. If you’re over 65, have osteoporosis or a history of cancer, contact your medical provider immediately.
