Compression Fracture

What causes a compression fracture?

Osteoporosis is the most common cause of compression fractures. Osteoporosis is a type of bone loss that causes bones to break easily.

Other causes include injuries to the spine (such as from car accidents and sports injuries) and tumors in the spine. The tumor may start in the vertebrae. But more commonly it spreads there from another part of the body to the bone.

Who is at risk for a compression fracture?

Osteoporosis is the most common cause of compression fractures. Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures. Most compression fractures linked to osteoporosis are found in women. This happens especially after menopause. But older men develop osteoporosis and compression fractures, too.

People who have had one compression fracture related to osteoporosis are at a higher than average risk of having another one.

What are the symptoms of a compression fracture?

Compression fractures may not cause symptoms when they first start developing. A healthcare provider may discover them on an X-ray that you had done for other reasons. Later symptoms may include:

• Back pain that gets slowly worse—lying on your back may relieve the pain and standing may make it worse
• A decrease in your height
• Limited movement in your spine (unable to bend or twist)
• A stooped-over posture, called kyphosis. Often, the front side of the vertebra loses height. But the rear side doesn't. As a result, these fractures can cause your posture to stoop forward over time.
• Numbness or tingling, weak muscles, problems walking, and possible trouble controlling your bowels or bladder because of nerve damage

If the fracture happens rapidly, you may feel sudden, severe, disabling back pain.

How is a compression fracture diagnosed?

Your healthcare provider will talk with you about your health history and recent injuries, and do a physical exam. They will check to see where you have pain and whether your upper spine is hunched forward. The healthcare provider may also want to get pictures of your spine using X-rays, CT scans, or MRI.

You may need a bone density scan if your healthcare provider suspects osteoporosis. This is a special type of X-ray called a DEXA (dual-energy X-ray absorptiometry). These tests show if osteoporosis is the cause of the fracture.

How is a compression fracture treated?

Your healthcare provider will want to treat the osteoporosis if your compression fracture is related to osteoporosis. You may need to take bone-strengthening medicine and calcium and vitamin D supplements. Physical therapy and exercises may be recommended, too. These things help make your bones stronger and can help prevent other fractures.

Other types of treatment include:

• Pain medicine to relieve your back pain
• Bed rest for a short time. This can be followed by limited activity while your bones heal.
• Wearing a back brace
• Physical therapy to help you move better and strengthen the muscles around your spine

Different types of surgery are available and may be needed if other treatments aren't helping:

• Vertebroplasty. Using an X-ray for guidance, your surgeon uses a small needle to inject special quick-setting cement into your fractured vertebra. The cement provides support for the broken vertebra, strengthens the area, and usually results in pain relief.
• Kyphoplasty. This surgery is a lot like vertebroplasty. But before the cement is injected, small balloons are used to expand the fractured space to help make the vertebra taller. The balloons are removed. The empty space is then filled with cement.

You may need radiation therapy as well as surgery to remove some of the bone and treat the tumor if a cancerous tumor is causing your symptoms. You may need surgery to repair the bone and join vertebrae together if an injury has caused the fracture. This is a procedure called fusion.

What are possible complications of a compression fracture?

Complications of compression fractures include:

• Fractured bones that do not heal after treatment. This can lead to damage of the nearby vertebrae.
• Blood clots in the legs due to decreased mobility
• Kyphosis is a deformity also called dowager’s hump or humpback. It can lead to severe pain and problems with organs in the chest. These include the heart, lungs, and digestive organs.
• Spinal cord or nerve problems
• Chronic (long-lasting) pain

What can I do to prevent a compression fracture?

Preventing osteoporosis, or treating it if you have it, is the best way to help prevent compression fractures. Talk with your healthcare provider about a bone density test to see if you are at risk for osteoporosis. Then find out what you can do about it. To reduce your risk for osteoporosis and certain types of cancer, don’t smoke and limit alcohol use. Doing weight-bearing exercises to strengthen your muscles and bones, and balance exercises to reduce your risk of falling, are important, too.

If you have osteoporosis and want to start an exercise program, check with your osteoporosis specialist first. Exercise is critical to overall health. But you may need to not do certain exercises or change them. This depends on how bad your osteoporosis is.

Living with a compression fracture

Compression fractures caused by osteoporosis usually become less painful with medicines and rest. They usually heal within 3 months. But some can cause long-term problems. Medicines to treat osteoporosis can help prevent fractures in the future. But they don't help heal an existing fracture. If you have osteoporosis, it’s best to treat it before you develop any compression fractures.

In most cases, compression fractures caused by injuries heal in about 8 weeks. But it can take longer if surgery is needed.

Compression fractures caused by cancer have varying outcomes. It depends on the type of cancer and how well it responds to treatment.

When should I call my healthcare provider?

Call your healthcare provider if:

• You have back pain and think you may have a compression fracture, especially if you know you have osteoporosis, have had an injury to your back, or have cancer
• Your symptoms keep getting worse. These include pain, limited movement, and numbness.
• You have trouble controlling your bladder and bowel function

Key points about a compression fracture

• A compression fracture is a type of fracture or break in your vertebrae. These are the bones that make up your spine.
• Osteoporosis is the most common cause of compression fractures. Other causes include injuries to the spine and tumors.
• Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures.
• When compression fractures first start developing, they may not cause symptoms.
• Treatment of compression fractures may include medicine, rest, a back brace, or physical therapy. Sometimes, surgery is needed.
• The risk of new fractures can be reduced by doing regular weight-bearing exercises that increase strength. These also include balance exercises that reduce the risk for falls.
• Check with your osteoporosis specialist before starting an exercise program if you have osteoporosis.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.

Medical Reviewer: Rahul Banerjee MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

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