Compression Fractures

Overview

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 the spine to weaken and collapse. Over time, these fractures affect posture. The spine curves forward and the person looks “hunched over” (kyphosis).

Compression fractures usually happen in the thoracic (middle) part of the spine, especially in the lower thoracic area. Providers also call them vertebral compression fractures (VCF). They often result from osteoporosis. But they can also happen after trauma (such as a car crash) or as a result of tumors on the spine.

Providers treat compression fractures with medications and a special type of back brace. Some people require a minimally invasive procedure to strengthen the vertebrae and stabilize their spine.

How common are compression fractures?

Compression fractures are common. Almost 1 million compression fractures happen every year in the United States. These spine fractures are more common in older women who have osteoporosis (a condition that causes bones to become weak and brittle). They also happen in older men.

Providers estimate that 1 in 4 women over 50 years old have at least one compression fracture. They’re more likely to happen in women who've been through menopause. Nearly half of all people over 80 have had a compression fracture.

Symptoms and Causes

What are the symptoms of compression fractures?

Compression fracture symptoms range from mild to severe. Some people may not have symptoms. Their provider may discover the fracture when they do an X-ray for another condition. But many people are unable to stand or walk without pain. Symptoms of a fractured spine include:

  • Back pain, which can come on suddenly and last a long time (chronic back pain). It usually develops anywhere between the shoulders and the lower back. Pain usually gets better when you lie down, and it worsens when you stand or walk.
  • Decreased mobility or flexibility in the spine. You may not be able to twist or bend over.
  • Hunched over appearance (some people call this curved upper back a “dowager’s hump” or hunchback).
  • Loss of height as the vertebrae compress and the back curves.
  • Pinched nerves and nerve damage, which can cause tingling and numbness in the back and difficulty walking.
  • Problems controlling the bladder or bowels (these symptoms happen with severe, untreated fractures).

What causes compression fractures?

Most compression fractures result from osteoporosis. Bones naturally weaken with age. The vertebrae in the spine become flatter and narrower. Weakened bones are more likely to fracture.

If you have moderate osteoporosis, you might get a compression fracture from a fall or another type of accident. People who have severe osteoporosis can fracture a bone during daily activities. These can include getting out of a car, sneezing, coughing or twisting suddenly.

In younger people who don’t have osteoporosis, compression fractures usually result from trauma (such as a car accident) or cancer. Cancerous tumors can spread to the spine, weaken the vertebrae and cause the bones to break.

Who is more likely to get compression fractures?

Women over 50 have a higher risk of compression fractures due to osteoporosis. With age, the risk increases in people of all genders. People who have had a compression fracture in the past are more likely to have another one.

Diagnosis and Tests

How do healthcare providers diagnose compression fractures?

To diagnose a compression fracture, your provider will examine you and ask about your symptoms. During the exam, your provider:

  • Checks your spine’s alignment and your posture.
  • Gently pushes 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 order imaging studies to see pictures of the bones, muscles and soft tissues in your back. These imaging studies include:

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

Management and Treatment

How do healthcare providers treat compression fractures?

Compression fracture treatment focuses on relieving pain, stabilizing the bones in the spine and preventing another fracture. Depending on the severity of the fracture and your overall health, treatment may include:

  • Pain relief medication: Your provider may recommend over-the-counter non-steroidal 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.
  • Medications to strengthen bones: Drugs called bisphosphonates can slow further bone loss, stabilize the bones and prevent fractures. These drugs include ibandronic acid (Boniva®) and alendronic acid (Fosamax®).
  • Vertebroplasty or kyphoplasty: These minimally invasive procedures relieve pain, stabilize the bones and improve mobility. During vertebroplasty, your provider inserts a needle in the vertebra and injects bone cement. During kyphoplasty, they insert an inflatable device that they fill with cement. A vertebroplasty or kyphoplasty is an outpatient procedure, so you’ll go home the same day.

Prevention

Can I prevent compression fractures?

You may not always be able to prevent compression fractures. To reduce your risk of a compression fracture from osteoporosis, you should:

  • Avoid drinking alcohol excessively.
  • Eat a healthy diet and get enough vitamin D and calcium, which strengthen bones.
  • Quit smoking and using other tobacco products, since nicotine weakens bones and causes cancer.
  • See your provider for regular checkups, and take medications as prescribed to slow bone loss if you’re at risk of osteoporosis.

Outlook / Prognosis

What is the outlook for people with compression fractures?

The outlook varies depending on age, the type and severity of the fracture and overall health. Many compression fractures heal after a few months of rest, limited movement and medications.

If you have osteoporosis, you have a higher chance of another compression fracture. You’re also more likely to break other bones, such as a hip.

Living With

When should I see my healthcare provider about compression fractures?

If you have sudden back pain that doesn’t get better after a day or two, see your provider. It’s important to get an evaluation for back pain so your provider can determine the cause and plan treatment. Call your provider right away if you’re over 65 or you have osteoporosis or a history of cancer.

A note from Cleveland Clinic

Compression fractures are very common and usually result from osteoporosis. Your risk of this type of fracture increases with age. To lower your risk of compression fractures, see your provider regularly, eat a healthy diet and get plenty of vitamin D and calcium. If you’re over 50, talk to your provider about getting a bone density test and taking medications to slow bone loss. See your provider if you have sudden back pain. When recovering from a compression fracture, follow your provider’s instructions so you can heal properly.

Last reviewed by a Cleveland Clinic medical professional on 10/02/2021.

References

  • American Academy of Orthopaedic Surgeons. Osteoporosis and Spinal Fractures. (https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis-and-spinal-fractures/) Accessed 10/25/2021.
  • American Association of Neurological Surgeons. Vertebral Compression Fractures. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures) Accessed 10/25/2021.
  • Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. (https://www.ncbi.nlm.nih.gov/books/NBK448171/) [Updated 2020 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Accessed 10/25/2021.

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