Compression Fracture – Causes, Symptoms & Treatment
A compression fracture is a type of bone break in which a vertebra collapses under pressure. It is most commonly linked to osteoporosis and causes back pain.
Things worth knowing about "Compression fracture"
A compression fracture is a type of bone break in which a vertebra collapses under pressure. It is most commonly linked to osteoporosis and causes back pain.
What is a Compression Fracture?
A compression fracture is a type of bone fracture in which a bone – most commonly a vertebral body in the spine – is compressed and loses height under axial pressure. The affected vertebra may collapse into a wedge shape, reducing the overall height of the spine. Compression fractures are among the most frequent fracture types in older adults and are closely associated with osteoporosis (bone loss).
Causes
Compression fractures can result from several causes:
- Osteoporosis: The most common cause. Reduced bone density makes the vertebrae so fragile that everyday activities such as coughing, sneezing, or bending can trigger a fracture.
- Trauma: Falls from height, motor vehicle accidents, or sports injuries can cause compression fractures even in healthy bones.
- Bone metastases: Cancer spreading to the bones weakens the bone structure and significantly increases fracture risk.
- Long-term corticosteroid therapy: Prolonged use of corticosteroid medications can reduce bone density and raise the risk of compression fractures.
Symptoms
Symptoms of a compression fracture vary depending on severity and cause:
- Sudden onset of back pain, most commonly in the thoracic or lumbar spine
- Pain that worsens with standing or walking and eases when lying down
- Loss of height and progressive rounding of the upper back (kyphosis)
- In severe cases: radiating pain into the legs, numbness, or weakness due to pressure on the spinal cord or nerves
- Reduced mobility and difficulty performing daily activities
Diagnosis
Diagnosis of a compression fracture is based on a combination of physical examination and imaging:
- X-ray: The initial imaging study to detect vertebral deformities and height loss.
- Magnetic resonance imaging (MRI): Allows assessment of acute fractures, soft tissue involvement, and potential nerve or spinal cord compression.
- Computed tomography (CT): Provides detailed information about bone structure and the extent of the fracture.
- Bone density scan (DXA): Used to assess underlying osteoporosis.
- Laboratory tests: To rule out secondary causes such as bone metastases or metabolic disorders.
Treatment
Treatment depends on the severity of the fracture, the patient's age, and overall health status.
Conservative Treatment
- Pain management: Use of analgesics, anti-inflammatory drugs, and if necessary, muscle relaxants.
- Rest and immobilization: Short-term bed rest followed by gradual mobilization.
- Orthoses and braces: Supportive devices to unload the spine and reduce pain.
- Physiotherapy: Targeted exercise programs to strengthen back muscles and improve posture.
Surgical Treatment
- Vertebroplasty: A minimally invasive procedure in which bone cement is injected into the fractured vertebra to stabilize it and relieve pain.
- Kyphoplasty: Similar to vertebroplasty, but a balloon is first inserted to restore vertebral height before the cement is injected.
- Spinal fusion or stabilization surgery: In cases of severe instability or nerve involvement, open surgery may be required.
Treatment of the Underlying Condition
In osteoporosis-related compression fractures, treating the underlying osteoporosis is essential to prevent further fractures. This includes medications such as bisphosphonates, adequate calcium and vitamin D intake, and regular physical activity.
Prognosis and Prevention
The prognosis depends largely on the cause and severity of the fracture. Many patients recover well with timely treatment. Prevention strategies include a calcium- and vitamin D-rich diet, regular weight-bearing exercise, and early management of osteoporosis. Fall prevention measures – especially in older adults – are also of great importance.
References
- Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. The Lancet, 2011;377(9773):1276–1287. doi:10.1016/S0140-6736(10)62349-5
- World Health Organization (WHO). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series, 1994. Available at: https://www.who.int
- Kado DM et al. Vertebral fractures and mortality in older women. Archives of Internal Medicine, 1999;159(11):1215–1220. doi:10.1001/archinte.159.11.1215
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