Vertebral compression fracture

George Rappard, MD

Symptomatic vertebral compression fractures are a significant cause of back pain in the United States. These fractures affect 25% of all postmenopausal women and the occurrence increases with age, reaching 40% in women over 80 years old. Less common in men, vertebral compression fractures are still of concern in elderly males. Vertebral compression fractures occur when the load bearing front part of the spinal column fractures. These fractures result in a cracking and compression of the bone. This bony compression results in a loss of height of the vertebral body, resulting in scoliosis, kyphosis (a forward bending of the spinal column often seen in the elderly) and even shortness of a person’s stature. In many cases vertebral compression fractures will heal with time, resulting in a loss of pain. The resultant deformity, however, will continue. In some cases, bony healing does not occur and in these cases the pain may continue to be quite severe. Patients with vertebral compression fractures typically suffer a pain in the middle of their back at the level of the fractured vertebra. Gentle pushing in the region will elicit tenderness. The pain typically worsens with movement, sitting or standing. In some cases, the pain may be so severe that a patient may be unable to walk. In cases of low back fractures, the pain may radiate to the hip and thigh. Usually, vertebral compression fractures are found in the elderly and are caused by osteoporosis, a condition that leads to thinning of the bones. Osteoporosis in the elderly is usually caused by changes in hormone levels brought on by aging. In younger patients, it may be caused by diseases of bony metabolism. In both the elderly and young, Vertebral compression fractures can be seen on x-ray. To find out if the fracture has healed or not an MRI can be ordered. This will show swelling in the bone. A bone scan, called a DEXA scan, can determine if the fracture is due to osteoporosis. The first line of treatment in bone pain due to vertebral compression fractures is conservative management, which consists of back rest, including bracing, and pain medications. If this fails, patients may be considered for minimally invasive treatments like vertebral body augmentation or vertebroplasty. Patients should undergo at least two to four weeks of conservative managements, depending on the disability associated with their pain. Importantly, the underlying cause of the fracture should be addressed. In osteoporosis this would consist of medications designed to harden or strengthen bone. Not addressing the cause of fracture could lead to new fractures shortly after a corrective procedure.

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