Compression Fracture of the Vertebrae

What is a compression fracture of the vertebrae?

A compression fracture is crumbling or collapse of small sections of the bones of the spine that occurs without any obvious cause, such as an injury. The bones of the spine are called vertebrae. More of the crumbling or collapse happens in the front of the bone than the back, causing the spine to bend forward.

How does it occur?

Compression fractures in older adults are usually the result of osteoporosis. Osteoporosis causes bones to lose calcium and become more porous, thinner, and weaker. "Dowager's hump," a curving of the spine most often seen in older women, is caused by osteoporosis. About 20% of women have a compression fracture of the spine by age 70.

Osteoporosis usually develops in women after menopause, between the ages of 45 and 55. It is most common in white and Asian women, especially slender women, but it can occur in women of any race. You are also at higher risk if you have a family history of osteoporosis.

In addition to aging, other risk factors for osteoporosis are:

• lifestyle habits such as:
  • smoking
  • having more than 1 drink of alcohol a day
  • too little calcium in the diet
  • not enough weight-bearing exercise such as walking, dancing, or lifting weights
• surgical removal of the ovaries, which reduces estrogen levels
• long-term use of certain medicines, such as steroids used to treat asthma or arthritis, thyroid medicines, anticonvulsants, certain cancer treatments, and aluminum-containing antacids
• chronic diseases that affect the kidneys, lungs, stomach, or intestines or change hormone levels (examples of such diseases are diabetes, hyperthyroidism, and congestive heart failure)
• intense exercise (such as marathon running), which reduces estrogen levels
• long periods of bed rest during serious illness, which speeds up the loss of calcium from bones
• eating disorders or too much dieting, which reduce estrogen levels.

What are the symptoms?

Only about half of the people with compression fractures have symptoms. The most common symptom is sudden, severe pain in the lower back or mid-back. The pain may extend throughout the back, hips, and legs. It may get worse when you sit or stand. It can make moving or trying to walk very difficult. Many people recall the exact moment the pain started and what they were doing at the time. Often, the fracture occurs during routine chores such as making a bed, opening a door, or picking something up from the floor.

You may have a compression fracture without knowing it. It does not always produce severe pain or a change in the way your body works. Over time, compression fractures may cause you to become shorter by as much as several inches.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. A painless bone mineral density (BMD) test can determine if you have osteoporosis and to what degree. An X-ray of the spine is needed to confirm the diagnosis of a compression fracture.

How is it treated?

Treatment for a compression fracture may consist of:

• bed rest until your pain decreases, then increasing your level of activity gradually, according to how much you feel you can do
• wearing a corset or back brace to make you more comfortable by giving the fractured area added support
• taking medicine for pain such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid (narcotic) pain medicines
• physical therapy to strengthen spinal muscles
• vertebroplasty. This procedure is done in a hospital by an orthopedic surgeon or interventional radiologist. A needle is inserted in the spine and special cement is injected into the weakened vertebrae. This process stiffens them and helps eliminate pain.
• kyphoplasty. This procedure is similar to the vertebroplasty except that it uses an inflatable "balloon tamp" instead of just an injection. Your healthcare provider makes a very small cut in the skin and inserts a small tube containing a deflated balloon. The balloon tamp is guided into the right place and inflated. The fractured vertebra is lifted up as the balloon expands. Once the vertebra height has been restored, the vertebra is filled with bone cement and the balloon is removed. Kyphoplasty helps keep the spine from curving too much and reduces pain from fractures.

As your fracture heals, you will have less pain and will be able to do more. You may find assistive devices such as a cane or walker helpful in getting around. Avoid stretching or stooping to prevent further injury. When you feel pain in your back, stop what you are doing and apply either heat or cold, whichever feels better.

How can compression fractures be prevented?

Having a healthy lifestyle with a good diet that includes enough calcium and vitamin D and regular, weight-bearing exercise can help prevent or reduce the severity of osteoporosis. Speak with your healthcare provider about other ways of reducing your chances of developing it.

If you have osteoporosis, ask about treatment. Estrogen hormone therapy after menopause has been shown to slow the bone thinning process. In the past, hormone therapy has been suggested for women at risk for osteoporosis. However, there are risks that go along with hormone therapy. Discuss the risks and benefits with your healthcare provider. There are several medicines that slow bone loss and help reduce fractures. These include:

• bisphosphonates such as risedronate (Actonel) and alendronate (Fosamax)
• calcitonin-salmon hormone (Miacalcin nasal spray)
• selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) and tamoxifen (Nolvadex).

Using your body wisely when doing everyday tasks may help prevent compression fractures. For example:

• Avoid lifting heavy objects.
• Avoid unusually vigorous physical activity. Build your activity level gradually.
• Wear shoes that provide good support (such as running or walking shoes).
• Use support for walking, such as a cane, if you need it.
• Bend your legs rather than your back when you pick up something from the floor.
• Hold objects close to your body when lifting them.
• When getting out of a chair, put your weight over your feet and slide to the front of the chair. Then, using the arms of the chair, raise yourself to a standing position.
• Stop smoking.