Overview

A vertebral compression fracture (VCF) occurs when a bony block or vertebral body in your spine suddenly collapses. Older people and those living with osteoporosis are at an increased risk of experiencing a VCF at some point in their life. Osteoporosis weakens bones until they are brittle enough to collapse during daily activities, such as opening a window, twisting, or bending. Severe cases of osteoporosis can cause a VCF when performing routine, innocuous activities, such as coughing or sneezing. While osteoporosis is the leading cause of VCF, trauma or injury can also cause a spinal collapse. 

VCFs are also known as a vertebral fracture, osteoporotic fracture, and wedge fracture. They are rarely associated with permanent nerve or spinal cord damage but can compress these areas, resulting in less blood and oxygen reaching them. Blood clots can form in the legs due to decreased usage. 

Vertebral fractures often result in a permanent loss of height and lifelong severe, chronic pain. Spinal deformity and muscular atrophy are common symptoms of a fractured spine, and in rare circumstances, your internal organs may become crowded following a VCF. 

The most common location for a wedge fracture is the thoracic spine, but these can occur in any part of the spine. You can sustain multiple compression fractures in different parts of your back simultaneously. While you can effectively treat a VCR at home by resting, you should seek medical attention to identify the cause of the fracture and ensure there are no other injuries to the surrounding nerves or spine. 

A compression fracture will typically heal itself through rest in around three months; however, you should still seek medical attention to identify the cause of the fracture. If you recently sustained trauma to your back, diagnostic testing can identify any other injuries to the surrounding nerves or spine. Medical professionals will be able to run tests to see if you have osteoporosis and create a treatment plan. Those who sustain one osteoporotic fracture are more likely to have another in the future, but properly treating osteoporosis can decrease that risk. 

VCFs are highly underdiagnosed by doctors or those experiencing one because they automatically assume the cause of the back pain is a muscle strain or soft tissue injury. Researchers estimate only one-third of all VCFs that occur in the United States per year are actually diagnosed as such. The diagnosis process for a compression fracture can be long and arduous; however, identifying the underlying cause is pivotal for creating an effective treatment plan. 

Treatment options 

• Rest
• Ice therapy 
• Pain medication: Over-the-counter pain medication and prescription muscle relaxants and pain medication can alleviate nerve or bone pain.
• Back brace to support your back and limit your fractured vertebrae’s movement as it heals.
• Surgery: vertebroplasty or kyphoplasty

If osteoporosis caused your VCF, your healthcare professional will discuss treatments, which may include physical therapy, vitamin D and calcium supplements, and hormone replacement therapy.

Symptoms

• Decreased pain when lying on back
• Deformity 
• Height loss
• Increased pain when standing or walking
• Limited spinal mobility
• Sudden onset of back pain
• Back pain travels into the arms or legs
• Numbness or weakness in arms or legs

Some patients report feeling no back pain following a VCF, while others report excruciating back pain. Those who experienced no back pain typically noticed the other symptoms associated with a compression fracture.

Diagnostic tests

You should seek medical attention for any back injury or suspected compression fracture if you:

• Are over 65 years old or under 12 years old
• Are experiencing back pain that has not gotten better after several months or progressively worsens
• Experience a sudden, sharp increase in back pain without sustaining any trauma
• Have or had any type of cancer
• Experience a high fever, loss of control of your bowels or bladder, or severe pain accompanied by numbness and weakness in your limbs
• Recently sustained an injury or trauma to your back

These may indicate the presence of a vertebral compression fracture or may make you more susceptible to sustaining one. 

Your healthcare professional will inquire about the frequency, severity, and duration of your back pain during your appointment. They will ask about your medical history and if anyone in your family has or had similar symptoms. If you recently sustained a trauma to the back, inform your doctor, as this will help them better diagnose the cause of your back pain. 

Before ordering any diagnostic tests, your doctor will perform a physical exam to look for any physical deformities on the spine and test for any spinal tenderness or sensitivity. They will test your reflexes, muscular strength and range of motion, and sensory perception. Once they complete the physical exam, they will likely order diagnostic tests such as:

• X-ray
• CT Scan
• MRI
• Dual-energy x-ray absorptiometry or bone density test
• Nuclear bone scan

Your medical professional will use these tests to rule out possible confounding causes of your back pain and investigate any structural or muscular damage caused by a compression fracture. Bone density tests can quickly identify osteoporosis. If diagnosed with osteoporosis, you may need routine bone density tests to track the progression of the disease and adjust your treatment regimen. 

You may need routine bone scans or other diagnostic testing to track the progression of your osteoporosis. 

Causes

Osteoporosis is the leading cause of vertebral compression fractures, and the severity of this disease affects what activities may cause a VCF. For those living with mild to moderate osteoporosis, daily activities such as opening a window or cleaning may cause a compression fracture. For those with severe osteoporosis, sneezing and coughing could result in a fracture. 

Other causes of wedge fractures include:

• Trauma to the spine: car accidents, injuries, falls
• Metastatic tumors: Cancer related tumors can destroy parts of the vertebra until they are weak enough to collapse. 

Facts 

• Vertebral compression fractures are more common in older people, especially in postmenopausal women. 
• Approximately forty percent of women will sustain at least one VCF by the time they reach age eighty. 
• About 750,000 people sustain a VCF each year.
• Those who sustain an osteoporotic VCF are five times more likely to sustain a second.