Compression Fracture

What are compression fractures?

A compression fracture is a type of fracture or break in your vertebrae. The vertebrae are the bones in your back that are stacked on top of each other to make your spine. Your spine supports your weight, allows you to move, and protects your spinal cord and the nerves that go from it to the rest of your body.

Compression fractures can cause the vertebrae to collapse, making them shorter in height. This collapse can also cause pieces of bone to press on the spinal cord and nerves, decreasing the amount of blood and oxygen that gets to the spinal cord.

What causes compression fractures?

Osteoporosis is the most common cause of compression fractures. Osteoporosis is a type of bone loss that causes bones to break easily.

Other causes include injuries to the spine (such as from car accidents and sports injuries) and cancer tumors in the spine (the cancer may start in the vertebrae, but, more commonly, it spreads there from another part of the body to the bone).

Who is at risk for compression fractures?

Osteoporosis is the most common cause of compression fractures. Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures. Most compression fractures linked to osteoporosis are found in women, especially after menopause, but older men develop osteoporosis and compression fractures, too.

People who have had one compression fracture related to osteoporosis are at a higher than average risk for having another one.

What are the symptoms of compression fractures?

When compression fractures first start developing, they may not cause symptoms. A doctor may discover them on an X-ray that you had done for other reasons. Later symptoms may include:

• Slowly worsening back pain — lying on your back may relieve the pain and standing may make it worse
• A decrease in your height
• Limited movement in your spine (unable to bend or twist)
• A stooped-over posture, called kyphosis (Often, the front side of the vertebra loses height, but the rear side doesn't. As a result these fractures can cause your posture to stoop forward over time.)
• Numbness or tingling, weak muscles, problems walking, and possible trouble controlling your bowels or bladder because of nerve damage

If the fracture happens rapidly, you may feel sudden, severe, disabling back pain.

How are compression fractures diagnosed?

Your doctor may will talk to you about your medical history and recent injuries and do a physical exam. He or she will check to see where you have pain and whether your upper spine is hunched forward. The doctor may also want to get pictures of your spine using X-rays, CT, or MRI scans.

If your doctor suspects osteoporosis, you may need a special type of X-ray called a dual-energy X-ray absorptiometry (DEXA) or bone density scan. These tests show if osteoporosis is the cause of the fracture.

How are compression fractures treated?

If your compression fractures are related to osteoporosis, your doctor will want to treat the osteoporosis. You may need to take bone-strengthening medicine and calcium and vitamin D supplements. Physical therapy and exercises may be recommended too. These things help make your bones stronger and can help prevent other fractures.

Other types of treatment include:

• Pain medicine to relieve your back pain
• Bed rest for a short time, followed by limited activity while your bones heal
• Wearing a back brace
• Physical therapy to help you move better and strengthen the muscles around your spine

Different types of surgery are available and may be needed if other treatments aren't helping:

• Vertebroplasty: Using an X-ray for guidance, your surgeon uses a small needle to inject special quick-setting cement into your fractured vertebra. The cement provides support for the broken vertebra, strengthens the area, and usually results in pain relief.
• Kyphoplasty: This surgery is a lot like vertebroplasty, but before the cement is injected, small balloons are used to expand the fractured space to help make the vertebra taller. The balloons are removed, and then the empty space is filled with cement.

If cancer is causing your symptoms, you may need radiation therapy as well as surgery to remove some of the bone and treat the tumor. If an injury has caused the fracture, you may need surgery to repair the bone and join vertebrae together, a procedure called fusion.

What are the complications of compression fractures?

Complications of compression fractures include:

• Fractured bones that do not heal after treatment; this can lead to damage of the nearby vertebrae
• Blood clots in the legs due to decreased mobility
• Kyphosis (a deformity also called dowager’s hump or humpback) that can lead to severe pain and problems with organs in the chest (such as the heart, lungs, and digestive organs)
• Spinal cord or nerve problems
• Chronic (long-lasting) pain

What can I do to prevent compression fractures?

Preventing osteoporosis, or treating it if you have it, is the best way to help prevent compression fractures. Talk to your doctor about a bone density test to see if you are at risk for osteoporosis and then find out what you can do about it. To reduce your risk of osteoporosis and certain types of cancer, don’t smoke and limit alcohol use. Weight bearing exercises to strengthen your bones and being careful to reduce your risk of falling are important too.

Living with a compression fracture

Compression fractures caused by osteoporosis usually become less painful with medicines and rest. They usually heal within 3 months, but some can cause long-term problems. Medicines to treat osteoporosis can help prevent fractures in the future, but does not help heal an existing fracture. If you have osteoporosis, it’s best to treat it before you develop any compression fractures.

In most cases, compression fractures caused by injuries heal in about 8 weeks, but it can take longer if surgery is needed.

Compression fractures caused by cancer have varying outcomes depending on the type of cancer and how well it responds to treatment.

When should I call my healthcare provider?

Call your healthcare provider if:

• You have back pain and think you may have a compression fracture (especially if you know you have osteoporosis, have had an injury to your back, or have cancer)
• Your symptoms (such as pain, limited movement, numbness) keep getting worse
• You have trouble controlling your bladder and bowel function

Key points about compression fractures

• A compression fracture is a type of fracture or break in your vertebrae (the bones that make up your spine).
• Osteoporosis is the most common cause of compression fractures. Other causes include injuries to the spine and cancer.
• Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures.
• When compression fractures first start developing, they may not cause symptoms.
• Treatment of compression fractures may include medicine, rest, back brace or physical therapy. Sometimes surgery is needed.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.