Compression Fracture
A collapsed or crushed bone in the spine
Quick Facts
- Type: Spinal fracture
- Most common cause: Osteoporosis
- Typical site: Mid and lower back (thoracolumbar spine)
- Main symptom: Sudden or worsening back pain
Overview
A compression fracture is a break in which one of the bones of the spine, called a vertebra, collapses or is crushed so that it loses height. Instead of cracking apart like a long bone, the front of the vertebra caves in, giving it a wedge shape. These fractures most often occur in the middle and lower back.
Compression fractures are especially common in older adults whose bones have been weakened by osteoporosis. In these cases the bone can break under everyday stresses such as bending, lifting, or even coughing. When fractures stack up over time, they can cause loss of height and a stooped posture. With treatment, pain usually improves and further fractures can often be prevented.
Symptoms
Some compression fractures cause sudden, noticeable pain, while others develop quietly and are found only on imaging. Common symptoms include:
- Sudden back pain, often in the middle or lower back
- Pain that worsens with standing or walking and eases with lying down
- Limited spinal movement and difficulty bending or twisting
- Loss of height over time
- A gradually stooped or hunched posture
Although most compression fractures do not damage the spinal cord, a fracture that presses on nearby nerves can cause numbness, tingling, weakness in the legs, or problems with bladder or bowel control. These symptoms require urgent medical attention.
Causes
Compression fractures happen when the force on a vertebra exceeds the strength of the bone. The main causes are:
- Osteoporosis: By far the most common cause, especially in older adults and postmenopausal women. Weakened bone can collapse under minor stress.
- Trauma: A fall from a height, a car crash, or a hard landing can fracture an otherwise healthy spine.
- Cancer: Tumors that spread to the spine or conditions such as multiple myeloma can weaken a vertebra until it collapses.
- Other bone-weakening conditions: Long-term steroid use and certain metabolic diseases reduce bone strength.
Risk Factors
- Osteoporosis or low bone density
- Older age
- Being a postmenopausal woman
- Long-term use of corticosteroid medication
- A previous compression fracture
- Smoking and heavy alcohol use
- Certain cancers that can spread to bone
Diagnosis
Diagnosis usually involves a physical examination and imaging to confirm the fracture and look for its cause:
- X-rays: Show the collapsed, wedge-shaped vertebra.
- CT scan: Provides detailed views of the bone, useful after trauma.
- MRI: Helps determine how recent the fracture is and whether nerves are affected; it can also suggest cancer as a cause.
- Bone density (DEXA) scan: Measures bone strength and helps diagnose osteoporosis.
Treatment
Most compression fractures heal over several weeks with supportive care, and treatment also addresses the underlying bone weakness.
- Pain relief: Pain medication, rest in moderation, and gradual return to activity.
- Back brace: A brace can support the spine and reduce pain while the fracture heals.
- Physical therapy: Gentle exercises restore movement and strengthen the muscles that support the spine.
- Treating osteoporosis: Calcium, vitamin D, and bone-strengthening medication reduce the risk of further fractures.
- Minimally invasive procedures: For severe, persistent pain, vertebroplasty or kyphoplasty can stabilize the vertebra with bone cement.
- Surgery: Rarely needed, reserved for unstable fractures or those affecting the spinal cord or nerves.
Prevention
- Get enough calcium and vitamin D and take prescribed bone-strengthening medication if you have osteoporosis
- Do regular weight-bearing and balance exercises to keep bones and muscles strong
- Have bone density checked if you are at risk
- Reduce fall risks at home, such as loose rugs and poor lighting
- Avoid smoking and limit alcohol
When to See a Doctor
See a doctor for new or worsening back pain, especially if you are older, have osteoporosis, or notice loss of height or a stooping posture. Seek emergency care if back pain follows a significant fall or accident, or if you develop numbness, tingling, leg weakness, or loss of bladder or bowel control, which may mean the spinal cord or nerves are affected.
Frequently Asked Questions
What causes a spinal compression fracture?
The most common cause is osteoporosis, where weakened bone collapses under minor stress. Trauma such as a fall or car crash and bone-weakening cancers like multiple myeloma can also cause compression fractures.
How long does a compression fracture take to heal?
Many compression fractures heal over about 6 to 12 weeks with supportive care such as pain relief, a brace, and gradual activity. Treating any underlying osteoporosis is important to prevent new fractures.
Do compression fractures need surgery?
Most do not. They are usually managed with pain relief, bracing, and physical therapy. Minimally invasive procedures like kyphoplasty may help severe pain, and surgery is reserved for unstable fractures or those affecting the nerves.
Can a compression fracture cause permanent problems?
Single fractures often heal well, but repeated fractures can cause lasting height loss and a stooped posture. Rarely, a fracture presses on nerves, causing leg weakness or loss of bladder control, which needs urgent care.
How can I prevent compression fractures?
Keep bones strong with adequate calcium and vitamin D, weight-bearing exercise, and bone-strengthening medication if prescribed. Preventing falls and avoiding smoking and heavy alcohol use also lower the risk.
References
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Osteoporosis.
- American Academy of Orthopaedic Surgeons (AAOS). Spinal compression fractures.
- Mayo Clinic. Compression fractures.
- MedlinePlus, U.S. National Library of Medicine. Vertebral compression fractures.