What is a Compression Fracture?
A vertebral compression fracture is when a part of a vertebral body in the spine collapses. Most compression fractures happen in the front of the vertebrae in the thoracic spine (middle of the back) and sometimes in the lumbar spine (lower back).
As the vertebrae breaks down over time, the compromised portion collapses, losing height and becoming compressed. Loss of vertebral height is the chief measure by which compression fractures are diagnosed. Most pathologic fractures, including those associated with osteoporosis, are compression fractures.
A vertebral compression fracture can compromise the spinal canal, crowding the spinal cord and causing spinal stenosis and a kind of pain called myelopathy. Or the crumbling bone can compress a spinal nerve, causing a pinched nerve, also known as radiculopathy.
One study places the incidence of a compression fracture at one in six women and one in 12 men; however, most people dismiss their symptoms as being nothing more than normal aches and pains.
Among older adults with osteoporosis, 700,000 vertebral compression fractures occur every year. After age 50, Caucasian women in the United States have a 40% chance of a vertebral compression fracture during their lifetime. The risk for Caucasian men is lower than that of women.
What Causes Compression Fractures?
The sequence usually includes immobility and associated loss of muscle and bone mass, spinal arthritis, degenerative disc disease, and altered body mechanics that redistribute the work of supporting your body weight and facilitating movement.
Over time, these changes produce an exaggerated curvature in the thoracic spine. This abnormal front-to-back curvature is called kyphosis. Kyphosis can provoke pain, compromise respiratory function, and increase the risk of falling. Spinal fractures often occur, however, during normal activities as the bones of the spine become weak and brittle.
Certain diseases, such as rheumatoid arthritis, Parkinson’s disease, and primary aldosteronism (an adrenal gland disorder that causes high blood pressure) are associated with a higher risk of vertebral fracture.
Other things that have been linked to a higher risk of vertebral fracture include advanced age; a history of falls or fractures; alcohol or tobacco use; dementia or depression; a deficiency of estrogen, vitamin D, or calcium; and low body mass index (BMI), particularly in women. Use of thiazide diuretics for hypertension (high blood pressure) or loop diuretics for hypertension or heart failure is a risk factor as well.
Compression Fracture Treatments
Unlike other spinal conditions and disorders, more aggressive treatment might be appropriate as soon as a diagnosis of vertebral fracture is confirmed.
Conservative management—physical therapy and pain management, for example—might still be useful instead of or in addition to surgery in some patients. Be sure to discuss all the options with your doctor, and ask questions about anything that’s not clear.
Physical therapy is often used in the management of spinal conditions. The goals of therapy for a compression fracture are to strengthen the musculature surrounding the spine and improve your gait (walking pattern) and body mechanics.
For pain relief, your doctor can recommend over-the-counter pain relievers or prescribe effective non-opioid medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, certain antidepressant agents are useful for pain management even in patients without depression. Opioid (narcotic) pain relievers may be prescribed if necessary, depending on your diagnosis and medical history.
If your fracture is osteoporosis related, your doctor may also recommend one or more of the following to maintain bone mass, build bone mineral density, prevent future fractures, and/or relieve pain:
- Vitamin D
- Bisphosphonates such as Fosamax
- Hormone replacement therapy (HRT) (in women)
- Synthetic calcitonin, a naturally occurring hormone produced by the human thyroid gland
- Teriparatide, a recombinant form of parathyroid hormone (PTH)
Surgery for Spinal Fractures
Inspired Spine uses performs a minimally invasive surgery technique called percutaneous kyphoplasty (PKP). (Percutaneous simply means “through the skin.”)
In this procedure, the spinal surgeon uses a specialized bone tamp with an inflatable balloon to expand a collapsed vertebral body. This chamber is then injected with polymethylmethacrylate (PMMA), a cement, or an implant fills the disc space to provide stabilization as an alternative to spinal fusion.
This procedure reduces time under anesthesia, minimizes blood loss, lowers the risk of infection, shortens recovery time, and makes recovery much easier and less painful. A wealth of evidence, including a high rate of patient satisfaction, shows that kyphoplasty is effective in relieving pain and reducing the risk of subsequent vertebral fracture even in patients with a compromised spinal canal.