Compression Fractures

What is a compression fracture?

Compression fractures are small breaks or cracks in the vertebrae (the bones that make up your spinal column). The breaks happen in the vertebral body, which is the thick, rounded part on the front of each vertebra. Fractures in the bone cause your spine to weaken and collapse. Over time, these fractures can affect your posture.

Compression fractures can happen to any part of your spine, but they usually occur in the thoracic spine (middle section). Osteoporosis is a common cause of compression fractures, in addition to trauma (like after an accident) or tumors that weaken the bone.

A healthcare provider may treat these fractures with medications, a back brace or surgery, depending on the cause and severity of the bone break.

You may hear your provider refer to a compression fracture as:

• A spinal compression fracture.
• A vertebral compression fracture.

What are the three types of compression fractures?

The types of spinal compression fractures include:

• Wedge: The fracture forms on the front of the vertebra. The broken bone collapses and takes on a wedge shape. More than half of all compression fractures are wedge-shaped.
• Crush: The break is in the entire vertebra, not just one side. The bone collapses on itself.
• Burst: The break causes bone pieces to spread in multiple directions when it breaks. This is a serious break that requires immediate medical attention.

Compression fractures are either:

• Stable: The fractured bone usually doesn’t move out of place.
• Unstable: The fracture moves bone pieces out of place. They may interfere with nearby nerves and tissue. This typically only occurs if there are other fractures or the spinal ligaments are injured as well.

How common is a compression fracture?

Compression fractures are common. An estimated 1 to 1.5 million compression fractures happen every year in the United States.

What are the symptoms of a compression fracture?

The symptoms of a compression fracture may include:

• Sudden back pain (pain may get better with rest and worse when you move).
• Limited mobility and flexibility (difficulty standing, walking, bending or twisting).
• Tingling or numbness in your back (pinched nerves).
• Tenderness at the fracture site.
• Muscle weakness or spasms.

Compression fracture symptoms range from mild to severe. You may not notice or feel symptoms with mild fractures.

A common sign of a compression fracture is a loss of height. The fracture causes the bone to collapse, which may affect how tall you are.

What causes a compression fracture?

Pressure on or against the vertebrae in your spine may cause your spinal bones to break and collapse. Some of the most common causes of a compression fracture include:

• Osteoporosis: Your bones naturally weaken with age. Weakened bones are more likely to fracture. Severe osteoporosis fractures may happen while doing daily activities like getting out of a car, sneezing, coughing or twisting suddenly.
• Injuries or accidents: This could include falls, car accidents or other types of physical trauma.
• Cancer: Cancerous tumors can spread to your spine, weaken your vertebrae and cause the bones to break.

What are the risk factors for a compression fracture?

You may be more at risk of a compression fracture if you:

• Are assigned female at birth and have been through menopause.
• Have a condition that affects the strength of your bones.
• Are 50 years of age or older.
• Had a compression fracture before.

Studies show that an estimated 40% to 50% of people aged 80 or over experienced a compression fracture before.

What are the long-term effects of a compression fracture?

Long-term complications of a compression fracture may include:

• A forward-curving spine with a hunched-over appearance (kyphosis).
• Problems controlling your bladder or bowels.
• Chronic (long-lasting) pain.
• Future fractures.

How is a compression fracture diagnosed?

To diagnose a compression fracture, your provider will offer a physical exam to learn more about your symptoms. During the exam, your provider:

• Checks your spine’s alignment and your height and posture.
• Gently presses on different areas of your back to identify the source of pain.
• Looks for signs of nerve damage, which may include numbness, tingling or muscle weakness.

Your provider will also recommend imaging tests to see pictures of the bones, muscles and soft tissues in your back. These imaging studies include:

• A spine X-ray, CT scan or MRI to show images of your spine and look for fractures and other injuries.
• Dual-energy X-ray absorptiometry (DEXA) scan, which is a special type of X-ray that measures bone loss (bone density test).
• Myelogram, which is a procedure your provider uses along with an imaging test. Your provider injects a contrast dye into your spinal column before doing a CT scan or X-ray. The dye makes images clearer.
• Three-phase bone scan, which is an imaging test that takes three sets of pictures during three different visits.

In some cases, your provider may find a compression fracture while performing an imaging test for another reason.

What is the best treatment for compression fractures?

Compression fracture treatment focuses on:

• Relieving pain.
• Stabilizing the bones in your spine.
• Preventing another fracture.

Depending on the type and severity of the fracture, treatment may include:

• Pain relief medication: Your provider may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Or they may prescribe muscle relaxers or prescription drugs. Follow your provider’s instructions carefully when taking these medications.
• Braces: A special type of back brace can support your vertebrae. It can also relieve pain by reducing how much you move your spine. You may need to wear the brace for four to 12 weeks.
• Medications to strengthen bones: Medications called bisphosphonates can slow further bone loss, stabilize bones and prevent fractures if you have osteoporosis.
• Physical therapy: A physical therapist will teach you stretches and exercises to strengthen the muscles around your spine.
• Surgery (vertebroplasty or kyphoplasty): These are minimally invasive outpatient procedures that stabilize and support your vertebra with bone cement.

Can a compression fracture heal by itself?

Yes, some types of compression fractures can heal on their own. Healing can take several months. A healthcare provider may offer treatment options like a brace to make sure your spine heals as expected. Let your provider know if you have symptoms that interfere with your daily routine and mobility as you heal.

Can compression fractures be prevented?

You can’t prevent all causes of compression fractures.

One of the most common causes is osteoporosis. To reduce your risk of an osteoporosis-related compression fracture, you should:

• Protect yourself from injury and accidents (like removing tripping hazards and wearing a seatbelt).
• Eat balanced meals and get enough vitamin D and calcium to strengthen your bones.
• Quit smoking and using other tobacco products, as nicotine weakens bones.
• See your provider for regular checkups and take medications as prescribed to slow bone loss if you’re at risk of osteoporosis.

What’s the outlook for a compression fracture?

Your outlook after a compression fracture varies based on:

• The severity of the fracture.
• Your age.
• Your general health.
• Any underlying conditions you have.

Many compression fractures heal after a few months of rest and limited movement. If symptoms are bothersome, a healthcare provider may offer different treatment options to relieve pain.

If you have osteoporosis, you have a higher chance of having another compression fracture. Your provider can help you manage osteoporosis to prevent future fractures.

How long do compression fractures last?

As your spine bones heal, you may notice symptoms like pain decrease after about four weeks. It should completely heal after 12 weeks. Your age and other factors may affect your healing time.

What’s the life expectancy after a compression fracture?

A compression fracture is only one factor that helps calculate your life expectancy and it isn’t the only thing your provider will consider. For example, a first-time vertebral compression fracture may indicate to a provider that osteoporosis is progressing and taking a greater toll on your body, even if you’re in otherwise good health.

Know that your situation may or may not fit statistics. Your provider can give you the best information about what you can expect.

When should I see a healthcare provider?

Visit a healthcare provider if you have sudden back pain or other symptoms of a compression fracture that doesn’t resolve in a couple of days. It’s especially important to stay regular with visits to see your provider if you have osteoporosis.

Contact emergency services or visit the emergency room if you have sudden, severe back pain and:

• Weakness or numbness.
• A loss of bladder or bowel control.
• A fever.

What questions should I ask my healthcare provider?

If you have a compression fracture, you may want to ask your provider:

• What type of fracture do I have?
• What treatment do you recommend?
• Do I need surgery?
• Are there side effects of the treatment?
• How do I prevent future fractures?