Compression Fracture of the Spine

What happens in a compression fracture

Each vertebra has a cylinder-shaped body at the front that carries most of the body's weight. When the bone inside is thin, the front of the vertebral body can crumple under load. The back part usually stays intact, so the bone becomes wedge-shaped. This tilts the spine forward. Several wedge fractures in the upper back produce the rounded "dowager's hump" called kyphosis.

Most osteoporotic compression fractures are stable: the spinal cord is not at risk. High-energy injuries can cause a burst fracture, where bone fragments push backward toward the spinal canal. See vertebral fractures and spinal fractures for these traumatic injuries.

Causes and risk factors

• Osteoporosis: by far the most common cause. Fractures can follow bending, lifting a grocery bag, a sneeze, or getting out of bed.
• Cancer: multiple myeloma or cancer spread to the spine from the breast, lung, prostate, kidney or thyroid. Suspect it in people under 50, with a cancer history, or with fractures above T7.
• Trauma: car crashes, falls from height and sports injuries in younger people.

Risk factors for osteoporotic fractures:

• Age over 65, female sex and early menopause
• A previous fracture of any kind
• Long-term corticosteroid use (prednisone 5 mg or more daily for 3 months or longer)
• Smoking, heavy drinking, low body weight
• Low vitamin D or calcium, rheumatoid arthritis, overactive thyroid or parathyroid, and some cancer hormone therapies

Symptoms

• Sudden, sharp back pain, often after a minor movement
• Pain that is worse when standing, walking or twisting and better lying on your back
• Pain that can wrap around the ribs or belly
• Tenderness when the bone is pressed
• Loss of height and a stooped posture over time
• Shortness of breath, reflux or feeling full quickly when severe kyphosis compresses the chest and belly

Many compression fractures cause only a dull ache or no pain at all. They are found by chance on an X-ray or because someone has lost height.

Diagnosis

1. Examination: tenderness along the spine, height measurement and a nerve check of the legs.
2. X-ray: shows the loss of height and wedge shape.
3. MRI: shows whether the fracture is new (bone marrow swelling) or old, which matters for procedures. It also checks for cancer or nerve compression.
4. CT scan: if bone fragments may be pushing toward the spinal canal.
5. Bone density (DEXA) scan: a compression fracture from minor force means osteoporosis even if the DEXA score is not in the osteoporosis range.
6. Blood tests: calcium, vitamin D, kidney function, and protein tests for myeloma when indicated.

Treatment

Pain control and activity

• Acetaminophen (paracetamol) first, following the label dose. NSAIDs can help in the short term if your kidneys and stomach allow.
• A doctor may prescribe calcitonin for a few weeks after a new fracture, or short-term stronger painkillers.
• Limit bed rest to a few days. Prolonged rest weakens muscles and bones further.
• A back brace may be used for comfort for a few weeks.
• Physical therapy: gentle extension exercises, posture training and core strengthening once the acute pain settles.

Vertebral augmentation

Vertebroplasty (injecting bone cement into the fractured vertebra) and kyphoplasty (inflating a balloon first to restore some height, then injecting cement) can be considered for new fractures with severe pain that does not improve after a few weeks. Evidence of benefit over careful non-surgical care is mixed, so specialists select patients carefully.

Surgery

Open surgery with screws and rods is reserved for unstable fractures or nerve compression.

Treating osteoporosis

This prevents the next fracture. Options include bisphosphonates, denosumab, and bone-building medicines such as teriparatide, abaloparatide or romosozumab for people at very high risk, plus calcium and vitamin D.

Recovery and complications

Pain usually improves noticeably within 6 to 12 weeks, and the bone heals in about 3 months. Some people are left with chronic back pain. Possible complications are further fractures, kyphosis, reduced lung capacity, constipation, reduced mobility and, rarely, nerve compression.

Prevention

• Treat osteoporosis once diagnosed and take medicines as prescribed.
• Do weight-bearing and muscle-strengthening exercise, plus balance training such as tai chi.
• Prevent falls: good lighting, no loose rugs, grab bars, eye checks and medication reviews.
• Get enough calcium and vitamin D, avoid smoking and limit alcohol.
• Lift with your legs, keep loads close, and avoid deep forward bending and twisting.

Frequently asked questions

What does a compression fracture feel like?

It usually causes sudden, sharp or aching pain in the middle or lower back that gets worse with standing, walking or twisting and eases when lying down. Some fractures cause only mild aching or no pain, and are noticed later as height loss or a hunched back.

How long does a compression fracture take to heal?

The bone typically heals in about 8 to 12 weeks. Pain usually eases noticeably within 6 weeks and continues improving for up to 3 months. Some people have lasting back pain, especially after several fractures.

Can you walk with a compression fracture?

Yes, in most stable osteoporotic fractures, short walks are encouraged as soon as pain allows. Walking keeps muscles and bones stronger and prevents complications of bed rest. Avoid lifting and bending forward until your doctor or physical therapist says it is safe.

Is a compression fracture serious?

Most are stable and heal without surgery, but they matter because they signal weak bones. After one vertebral fracture, the chance of another within a year rises several-fold. Fractures with nerve symptoms or caused by cancer need urgent care.

Do compression fractures need surgery?

Most do not. Pain relief, activity and physical therapy are enough for most people. Vertebroplasty or kyphoplasty may help a severe painful fracture that does not improve, and open surgery is only needed for unstable fractures or nerve compression.