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Vertebral Compression Fracture

(Fracture, Vertebral Compression)

Definition

The bones of the back are called the vertebrae. A vertebral fracture is a break in one of these bones. A vertebral compression fracture usually occurs when the front part of the bone is squeezed or compressed. They are most common in the thoracic vertebrae.

Vertebral Fracture
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Causes  ^

A vertebral compression fracture can be caused by:

  • Osteoporosis—decreased bone mass and density
  • A blow to the back
  • Falling down
  • Landing on your heels when jumping from a height
  • Having major trauma such as a motor vehicle accident
  • Bone infection
  • Bone cancer

Risk Factors  ^

Factors that may increase your chances of vertebral compression fractures:

  • Osteoporosis
  • Previous vertebral fracture within the last year
  • Female gender
  • Older age
  • Trauma
  • Cancer
  • Chronic use of corticosteroids
  • Proton pump inhibitors
  • Poor mental functioning
  • Poor mobility
  • Poor strength

Symptoms  ^

Most people do not have symptoms. If present, symptoms may include:

  • Mild to severe pain in the middle or lower back
  • Numbness, tingling, or weakness
  • Difficulty walking

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done.

Images may be taken of your bodily structures. This can be done with:

You may be tested to determine if you have osteoporosis. This can be done with a bone mineral density test.

Treatment  ^

Treatment includes:

Surgery

  • Vertebroplasty—Liquid cement is injected into the vertebra. It can help relieve the pain associated with vertebral fractures. It is not suitable for everyone. The procedure may be best for recent fractures. Talk with your doctor to see if this option may be right for you. For example, it may not be as helpful in people whose fractures are due to osteoporosis.
  • Kyphoplasty—A balloon or other procedure is used to create a cavity. The cement is injected into the cavity. This procedure is designed to relieve pain. It can also improve spinal deformities from the fractures.
  • Spinal fusion may be used to join together 2 or more bones in the spine, although most commonly used for burst fractures. This procedure stops the bones from moving.

Nonsurgical Treatments

Your doctor may advise:

  • A brief period of bed rest and a decrease in activity
  • Medication to control the pain
  • Strengthening exercises for your back muscles
  • A back brace

Treatment for Osteoporosis

Medications

To prevent further bone loss, medications may include:

  • Estrogen/progesterone hormone replacement therapy
  • Bisphosphonates to prevent loss of bone mass
  • Estrogen agonist/antagonist to treat weak or thin bones
  • Calcitonin to regulate calcium levels in the body
  • Parathyroid hormone to regulate calcium and phosphate levels in the body

The following may also be advised:

  • Vitamin and mineral supplements, especially calcium combined with vitamin D
  • Lifestyle changes—These may include weight-bearing and resistance exercises for both the upper and lower extremities.

Prevention  ^

Building strong bones will help prevent fractures. However, most bone strength is attained by women before they are 25 years old. That makes maintaining bone density and strength at older ages even more important.

To help reduce your chances of a vertebral compression fracture:

  • Get plenty of weight-bearing exercise. This includes walking, jogging, or sports such as tennis.
  • Do resistance exercises for arms and legs. This will help to improve your strength and balance.
  • Get plenty of calcium, vitamin D, and protein in your diet. Talk to your doctor if you think you need supplements.
  • If you have osteoporosis, you should talk to your doctor about treatment options. If you had an early menopause, talk to your doctor about this.
  • If you smoke, talk to your doctor about ways to quit.
  • Drink alcohol only in moderation. Moderate alcohol intake is 2 drinks per day for men and 1 drink per day for women.
  • Remove any obstacles in your home that could cause you to fall. These may include throw rugs or furniture.
RESOURCES:

National Institutes of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov

National Osteoporosis Foundation
https://www.nof.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://coa-aco.org

Women's College Hospital—Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

Bone basics. National Institutes of Arthritis and Musculoskeletal and Skin Diseases website. Available at: https://www.bones.nih.gov/health-info/bone/bone-basics. Accessed December 19, 2017.

Committee on Practice Bulletins-Gynecology, The American Congress of Obstetricians and Gynecologists. ACOG Practice bulletin 129. Osteoporosis. Obstet Gynecol. 2012;120(3):718-734. Reaffirmed 2016.

Osteoporosis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113815/Osteoporosis. Updated September 11, 2017. Accessed December 19, 2017.

Thoracolumbar vertebral compression fracture. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114371/Thoracolumbar-vertebral-compression-fracture. Updated September 16, 2016. Accessed December 19, 2017.

Vertebral compression fractures. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures. Accessed December 19, 2017.

Vertebroplasty and kyphoplasty. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=vertebro. Updated January 23, 2017. Accessed December 19, 2017.

12/19/2017 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114371/Thoracolumbar-vertebral-compression-fracture: Buchbinder R, Golmohammadi K, Joshnston RV, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2015;(4):CD006349.

Last reviewed December 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 12/19/2017

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