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Compression fractures are tiny breaks in the vertebrae pf the spine that can add up to big trouble. Here are 10 things you need to know to recognize, prevent, and treat this common manifestation of osteoporosis.

Probably the most insidious but almost the most common symptom of the brittle bone disease osteoporosis is compression fractures. Microscopic breaks in bone that never get repaired, compression fractures accumulate over years, or even decades. They cause no symptoms at all other than a mysterious loss of height or a tendency to nod forward. Then they may cause unremitting pain and disabling immobility. The tragedy of these situations is that they are nearly always preventable. Here are 10 things people at risk for osteoporosis need to know.

Are you at risk for osteopososis? If you have ever had a "fragility fracture," a break in a bone without a high-impact event that caused it, you should be evaluated for the condition. If you have a family history of osteoporosis, get a referral to an endocrinologist who specializes in the disease by age 50 for women and by age 60 for men. If you take high doses of steroids for more than six months, you will experience some osteoporosis that needs treatment. And there is a very long list of medications and health conditions that cause loss of bone; please see other pages in this site.

1. Compression fractures of the spine are very common.

Every year in the United States alone, there are 100,000 hospital admissions for compression fractures. Another 600,000 people are diagnosed with compression fractures.

2. The tests for compression fractures are painless and quick.

Doctors diagnose compression fractures with a VFA, vertebral fracture assessment. This is a painless test done on the same table used for DXA,  dual energy x-ray absorptiometry. The procedure is covered by insurance, and if it is billed directly, it usually costs several hundred dollars before discounts. (Vertebral fractures can be identified by x-ray but using x-rays takes longer, exposes patients to more radiation, and costs several times as much.)

3. Compression fractures are usually treated non-surgically.

Conventional treatment includes pain medication, limitations on physical activity, changes in the living environment to prevent falls, physical therapy, and sometimes the use of a brace. Every case of compression fractures requires calcium and vitamin D supplementation, plus some kind of pharmaceutical therapy (usually a bisphosphonate medication like Fosamax or Reclast). The nutritional supplements are likely needed for life, but the medications are changed every few years.

4. Compression fractures most commonly affect the lower back.

Lower back pain that isn't triggered by activity and that just won't go away is a common presentation of compression fractures caused by osteoporosis. Wedges of bone come loose at the lower edges of vertebrae due to the force of gravity weighing on weakened bone over a period of years. Because the bone is losing its fight with gravity, the lower in the spine, the greater the probability of compression. Less commonly, the entire disk is crushed. These kinds of fractures usually occur in the lumbar spine.

5.  Once you have had one compression fracture, you tend to get more.

The mechanics of your spine change when a disk is fractured. You tend to favor one side over another. That puts strain on the rest of your spine and the muscles alongside it. Your muscles have to stretch out just a little more after every fracture, and that leads to muscle spasms and still more stress on already-weakened spine. This why it is so important to get diagnosis and treatment and stick to it.

6. Any tme you are diagnosed with compression fractures, you will be checked for underlying conditions.

By far the most common cause of compression fractures is osteoporosis, but in much rarer cases they can be caused by cancer or liver disease. Don't panic when your doctor tells you that you are being checked for some dire disease. It is just a necessary precaution.

7. The pain from compression fractures eventually resolves itself.

It may seem that your back aches 24/7 and nothing you take really helps. However, even without medication, pain goes away on its own in a few months.

8. There are some non-pharmaceutical interventions you can use to relieve pain.

Massage, over the counter pain relievers such as acetaminophen (Tylenol) and ibuprofen, heating pads, and bed rest relieve pain. There are a few problem areas with do-it-yourself pain relief. One is overdosing Tylenol. Too much Tylenol can damage your liver. Don't take Tylenol with alcohol. And don't spend all of your time in bed. A day to a week of rest may reduce acute pain, but you have to get up and move every day to prevent bedsores and blood clots, and you need light exercise to keep bone healthy.

9. You may need to change your exercise routine.

If you have compression fractures, you need to do exercises that strengthen your back, not your abs. Sit ups and crunches are usually a bad idea. Pilates and tai chi are usually helpful. In the early stages of recovery you may even need to do your routine with a back brace to immobilize the spine; your doctor will advise you.

10.  You always need to follow up on your initial diagnosis.

You probably need another VFA a year after your first diagnosis to make sure your treatment program is working. And if side effects of your medications are a problem, let your doctor know so you can get a different treatment. Untreated compression fractures tend to multiply. You need to persist in your new habits and with your supplements and meds to stay pain free.

  • Freedman BA, Potter BK, Nesti LJ, et al. Osteoporosis and vertebral compression fractures-continued missed opportunities. Spine J. 2008 Mar 14.
  • Hirsch JA, Beall DP, Chambers MR, et al. Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method. Spine J. 2018 Nov. 18 (11):2152-61.
  • Prather H, Watson JO, Gilula LA. Nonoperative management of osteoporotic vertebral compression fractures. Injury. 2007 Sep. 38 Suppl 3:S40-8.
  • Photo courtesy of SteadyHealth

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