Osteoporotic Compression Fractures

Article written by Michael D Burdi, MD

Osteoporosis is systemic skeletal disease characterized by compromised bone strength, which predisposes patients to fractures. Compression fractures involve collapse of the vertebral body in the thoracic or lumbar spine when the forces placed upon it exceed its strength.

Osteoporotic compression fractures can be caused by minimal trauma such as falls but can occur spontaneously from the force of gravity on the spine. Besides osteoporosis, metabolic disorders or tumors can also weaken bone and lead to compression fractures. Compression fractures may occur without significant symptoms but are usually characterized by pain in the spine at the location of the fracture. A hunchback deformity can develop, especially when multiple levels are involved. This is known as kyphosis and can affect breathing, and nutrition from the compressive effect on the chest and abdomen respectively. Although most fracture pain will improve with time, approximately a third will become chronically painful.

Patients experiencing sudden onset of severe pain in the spine occurring with or without associated trauma (such as a fall) should seek medical attention. Xrays may be taken to identify a fracture and in some instances an MRI or bone scan may be obtained to determine if the fracture occurred recently. Nonoperative treatment modalities include rest, pain medications, non-steroidal anti-inflammatory medication and back braces.

Some patients may go on to develop chronic debilitating pain despite an adequate trial of non-operative treatment modalities (usually 6 weeks to 3 months). In these patients, surgical intervention with kyphoplasty or vertebroplasty may provide significant relief. Vertebroplasty involves injecting bone cement into the compressed vertebra under high pressure. Kyphoplasty involves placing a balloon inside the collapsed body in order to create a cavity and help restore the height. The balloon is then deflated and withdrawn and the cavity is filled with bone cement under low pressure. Both techniques have been shown to be efficacious in relieving pain; kyphoplasty has a theoretical advantage of partially restoring the vertebral body height in some cases.

Whether patients with osteoporotic compression fractures are treated with non-operative or operative modalities, addressing the source of the fracture, namely the osteoporosis, is of paramount importance. Bone densitometry (DEXA SCAN) or other modalities are used to assess bone density, which can help guide treatment. Treatment options include exercise, hormone replacement, and anti-resorptive medication which help slow bone loss. Smoking, excessive alcohol consumption, inactivity and poor diet increase the chance of osteoporotic fractures. Avoiding these can help reduce the risk or severity of osteoporosis.