Vertebral Compression Fracture Overview

A vertebral compression fracture occurs when the bones of the spine become broken due to
trauma. Usually the trauma necessary to break the bones of the spine is quite large. In certain
circumstances, however, such as in elderly people and in people with cancer, these same bones
can break with little or no force. The vertebrae most commonly broken are those in the lower
back.

Vertebral Compression Fracture Causes

Osteoporosis
o This is a condition in which bone density is reduced, which may predispose a
person to a vertebral compression fracture with little or no trauma.
o Osteoporosis most commonly occurs in women who have gone through
menopause, but it can also occur in elderly men and in people who have had longterm use of a steroid medication such as prednisone.

Trauma: Injury severe enough to cause a vertebra to break can occur with a fall from a
tall height in which the person lands on his or her feet or buttocks. It can also occur in a
person involved in a car accident.

Pathologic fracture
o This term refers to a fracture occurring in the vertebra due to preexisting disease
at the fracture site.
o Most commonly, this type of break is from cancer in the bone, which has often
traveled from other sites in the body, such as from the prostate, breast, or lungs.
o

o The break may also occur because of a localized infection of the bone, called
osteomyelitis, which may occur in people with diabetes or in those who abuse IV
drugs.

Vertebral Compression Fracture Symptoms

Pain: It tends to be in the lower back but may occur in the upper back or neck. Some
people may also have hip, abdominal, or thigh pain.

Numbness, tingling, and weakness: Such symptoms could mean compression of the
nerves at the fracture site.

Losing control of urine or stool or inability to urinate: If these symptoms are present, the
fracture may be pushing on the spinal cord itself.

When to Seek Medical Care

A doctor should evaluate any back pain in these cases:

Any elderly person

A person with cancer

Anyone whose pain is exactly the same at rest as it is during activity

A person with unintentional weight loss

Seek medical help at a hospital's emergency department if you have the following symptoms in
association with back pain:

Loss of control of urine or defecation

Severe pain, numbness, or weakness

High fever

Exams and Tests

X-rays: People older than 65 years, who have cancer, or who have had significant trauma
should expect x-rays to be performed. If you are younger than 65 years and do not have
any medical problems or severe pain, then x-rays may not be necessary.

CT scan of spine: If a fracture (bone break) is discovered, then the doctor may want to do
a CT scan to determine the extent of the fracture.

MRI of spine: If you have incontinence or retention, weakness, or you are unable to feel
certain areas, then an MRI may need to be performed. Some hospitals do not have an
MRI. You may need to be transferred to another hospital to get the MRI.

Spine surgery consultation: If you have a severe fracture, then the emergency doctor may
call a specialist to examine you. This may mean that you need surgery for the fracture.
Surgery is normally reserved for those with severe pain, weakness, or inability to feel.

Vertebral Compression Fracture Treatment

Self-Care at Home

Rest

Pain relief

Apply ice to the injured area for the first week, then heat or ice, whichever feels better.
Ice should be applied in the following fashion: Place the ice in a bag, wrap the bag in a
towel, and then apply to the injured area for 15-20 minutes each hour. Heat applied in the
first week after an injury draws more fluid to the area, thereby increasing swelling and
pain.

When allowed by your doctor, a home stretching and strengthening program

Vertebral Compression Fracture Treatment

Self-Care at Home

Rest

Pain relief

Apply ice to the injured area for the first week, then heat or ice, whichever feels better.
Ice should be applied in the following fashion: Place the ice in a bag, wrap the bag in a
towel, and then apply to the injured area for 15-20 minutes each hour. Heat applied in the
first week after an injury draws more fluid to the area, thereby increasing swelling and
pain.

When allowed by your doctor, a home stretching and strengthening program

Medical Treatment

Back brace

Rest and ice to the area: Later use heat compresses on the area.

Admission to the hospital: Depending on severe pain, weakness, retention, or

incontinence, you may be admitted to the hospital.

Exercise: On clearance from the doctor, a stretching and strengthening program is

important to decrease further osteoporosis and to strengthen muscles supporting the back.

Medications

Pain medication
o Nonsteroidal anti-inflammatories such as ibuprofen (Advil, Motrin) or naproxen
(Aleve, Naprosyn)
o Narcotics such as hydrocodone
o Muscle relaxants such as cyclobenzaprine (Flexeril), carisoprodol (Soma),
diazepam (Valium

Surgery

Surgery may be required to prevent the spine from pressing on the spinal cord or to stabilize the
vertebra adjacent to the fracture site.

Other Therapy

Percutaneous vertebroplasty: This is a relatively new procedure in which a needle is

inserted through the skin by a specialist and a cement or "biomaterial" compound is
injected into the vertebra with the osteoporotic fracture. Studies using this technique have
shown promise in relieving chronic pain associated with osteoporotic fractures.

Next Steps
Follow-up
Follow the instructions exactly as given by the doctor, and ask questions if you are unsure what
to do.

Take the medications as prescribed.

Apply ice for the first week. A good rule of thumb is to place the ice in a bag, wrap the
bag with a towel, and then apply the ice for 15-20 minutes every hour. After the first
week, either ice or heat may be applied. Apply the one that makes the injury feel better.
Applying heat in the first few days after an injury draws more blood to the injury site,
thus increasing swelling and pain.

Avoid strenuous and painful activities until cleared by your doctor.

See your doctor frequently to ensure that the bones are healing.

Next Steps

Follow-up
Follow the instructions exactly as given by the doctor, and ask questions if you are unsure what
to do.

Take the medications as prescribed.

Apply ice for the first week. A good rule of thumb is to place the ice in a bag, wrap the
bag with a towel, and then apply the ice for 15-20 minutes every hour. After the first
week, either ice or heat may be applied. Apply the one that makes the injury feel better.
Applying heat in the first few days after an injury draws more blood to the injury site,
thus increasing swelling and pain.

Avoid strenuous and painful activities until cleared by your doctor.

See your doctor frequently to ensure that the bones are healing.

Prevention
The most important method of preventing vertebral compression fractures is to prevent
osteoporosis.

Eat a well-balanced diet.

Regular exercise including weight-bearing and strength-training exercise has been shown
to increase the strength of bone.

Stop smoking. Tobacco smoke has been shown to weaken bone.

All people at risk for osteoporosis should take calcium and vitamin D supplements.

In women past menopause, estrogen replacement therapy is likely indicated to prevent

osteoporosis. Two relatively new medications, alendronate (Fosamax) and risedronate
(Actonel), have been shown to reduce the development of osteoporosis. They have also
shown promise in decreasing the rate of bone loss in those who already have
osteoporosis.

If you are on daily steroid therapy for another medical condition, discuss with your
doctor methods of reducing the dosage of your steroid medication because decreasing the
doses reduces the chance of developing osteoporosis. In some medical conditions that
require steroid therapy, other medications may be useful in reducing your steroid dosage.

Outlook

The back fracture should heal in most cases without problems. However, severe fractures may
need surgery to keep the spine in alignment. Also, a pathological back fracture may not heal
because cancer may be present.
A person who has a fracture caused by osteoporosis can decrease the chance of further fractures
with adequate dietary supplementation (calcium), exercise, and hormone replacement, if
indicated.
Fractures causing chronic, severe pain benefit from a multidisciplinary approach that may
include the primary medical doctor, an orthopedic or neurosurgeon, physical therapy, and pain
clinic referral.
Synonyms and Keywords

broken back, spine fracture, wedge fracture, osteoporotic fracture, osteoporosis, osteomyelitis,
vertebral compression fracture