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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 occurs when the front part of the bone is squeezed or compressed.

Vertebral Fracture

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Causes

A vertebral compression fracture can be caused by:

  • Osteoporosis —a condition of weakened bones
  • 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
Risk Factors

Factors that increase your risk of vertebral compression fractures include:

  • Osteoporosis
  • Trauma
  • Cancer
  • Use of antipsychotic medications
  • Proton pump inhibitors
  • Poor mental functioning
  • Poor mobility
  • Poor strength
  • Previous vertebral fracture within the last year
Symptoms

Symptoms may include:

  • Mild to severe pain in the middle or lower back
  • Numbness, tingling, or weakness
  • Difficulty walking
  • Loss of control of the bowel or bladder
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 involves liquid cement being 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.

In kyphoplasty , a balloon 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 two or more bones in the spine. 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/progesterin 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.

Follow these prevention guidelines:

  • 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 two drinks per day for men and one 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
http://www.niams.nih.gov

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

CANADIAN RESOURCES:

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

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

References:

Bone basics. National Institutes of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Bone/Bone_Basics/. Accessed November 25, 2013.

Buchbinder R, Osborne RH, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. NEJM. 2009;361(6):557-568.

Kallmes DF, Comstock BA, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. NEJM. 2009;361(6):569-579.

Osteoporosis. American College of Obstetricians and Gynecologists Practice Bulletin. No. 50; 2004.

Osteoporosis. Am Fam Physician. 2009;79(3):201-202.

Ullom-Minnich P. Prevention of osteoporosis and fractures. Am Fam Physician. 1999;60(1):194-202.

Wardlaw D, Cummings SR, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 373(9668):1016-1024.

11/9/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568.



Last reviewed November 2013 by John C. Keel, MD; Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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