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Compression fractures of the spine can be painless, or excruciating painful. You may know exactly when they occurred, or simply find you are a lot shorter than you used to be years ago. Here is how to recognize fractures of the spine and what to do.

Spine fractures are the most common complication of osteoporosis. Every year, in the United States alone, about 750 thousand people suffer some kind of compression fracture of the spine. Most often, these fractures are found in the lowest and strongest part of the spine, the lumbar vertebrae, L1 through L5. About 25 percent of women will experience a spine fracture at some time after menopause. By age 80, about 40 percent of women endure a compression fracture. Spine fractures are also far from unknown in men.

What causes a fracture of the spine?

A compression fracture of the spine occurs with the collapse of a block of bone known as a vertebra. There may be no pain, or there may be severe pain. There can be loss of mobility and loss of height. Fractures of the spine are more common the lower you go down the spine. Cervical (neck) fractures are less common that thoracic (mid-spine) fractures, and lumbar (lower back) fractures are more common than either cervical or thoracic breaks.

In people under the age of 55, the most common cause of a compression fracture is metastatic cancer that has spread to bone. In people over 55, osteoporosis, loss of bone mineral content, is far more common. The triggering event for a compression fracture may be an identifiable trauma, but in severe osteoporosis it may be "the last straw" that snaps a weakened bone. Something as slight as sneezing or turning suddenly may be cause the bone.

Older people who go to the ER for care of acute back pain or non-traumatic spine fractures seldom get appropriate treatment, at least in the United States. Medical student David W. Barton, a medical student at the Virginia Tech Carilion School of Medicine, Roanoke, and coworkers found that only 0.6 percent of people admitted to the ER for symptoms of spine fracture received DXA scanning to rule out osteoporosis. Only five percent received any medication for osteoporosis. But 74 percent of patients had to be readmitted to the ER and/or hospital for a spine fracture at some time during the next two years.

What are the symptoms of a spine fracture?

Acute symptoms of a fracture to the spine may include intense pain. Usually the pain is worse when standing or walking and it improves on lying down. With time there may be loss of mobility and the spine may "settle" so that there is loss of height.

What usually goes wrong when you go to the ER with a spine fracture

Emergency room doctors usually correctly diagnose compression fractures of the spine. It only takes an X-ray, not a more comprehensive DXA scan, to tell that a fracture has occurred.

Where things go wrong is that there is almost never any professional in the ER to take ownership of the patient's care to make sure that appropriate follow-up care is offered. Patients are told to check in with their primary care doctors after the ER visit, but the primary doctor is not primarily interested in bone health. Treatment of osteoporosis may be an afterthought or neglected altogether. Or the patient is referred to an orthopedic surgeon, who is primarily interested in surgical intervention. The treatment of compression fractures is with medication, not surgery. The orthopedist makes no recommendations, because typically these would be the area of expertise of an endocrinologist who specializes in osteoporosis.

In the United States, fewer than 25 percent of people who are seen in the emergency room for a compression fracture of the spine start even the most basic treatment for osteoporosis, such as taking supplemental calcium and vitamin D. 

It isn't enough for the ER doctor to tell you that you have a spine fracture and send you home with a prescription for pain pills. You need follow up to prevent future fractures with debilitating consequences. Here's what you need to do if you have been told you have a compression fracture of the spine:

  • Make sure you are seen by a doctor who specializes in osteoporosis. This will not be your primary care physician. This will not be an orthopedic surgeon. This may be a doctor who is credential in family practice or internal medicine who specializes in osteoporosis, but most likely you need to see an endocrinologist.
  • Make sure you get at least a DXA scan to test for osteoporosis. The DXA scan will not detect spine fractures. This is done with conventional X-rays or something called VFA. But you need DXA to know whether demineralization is occurring in your spine and other vulnerable bones so you can take timely measures for prevention. It is especially important not to allow a vertebra to collapse by more than 50 percent. When one vertebra collapses, a segment of the spine may become unstable and adjacent vertebrae may also collapse. Eventually the spine compresses inner organs.
  • Be ready to start a holistic treatment program to prevent future fractures. Once you have had one compression fracture, you are at risk for more. An osteoporosis specialist will likely put you on medications to help conserve and restore bone. You will probably need to make changes in your diet, and you will need to make sure that your home and workplace are as fall-proof as possible. But positive changes will help you maintain your independence and a pain-free active life, working with your doctor to achieve your best bone health.

  • Barton DW, Behrend CJ, Carmouche JJ. Rates of osteoporosis screening and treatment following vertebral fracture. Spine J. 2019 Mar.19(3):411-417. doi: 10.1016/j.spinee.2018.08.004. Epub 2018 Aug 22.PMID: 30142455.
  • Barton DW, Griffin DC, Carmouche JJ. Orthopedic surgeons' views on the osteoporosis care gap and potential solutions: survey results. J Orthop Surg Res. 2019 Mar 6.14(1):72. doi: 10.1186/s13018-019-1103-3.PMID: 30841897.
  • Dell RM, Greene D, Anderson D, Williams K. Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am. 2009.91(Suppl 6):79–86. doi: 10.2106/JBJS.I.00521.
  • Photo courtesy of SteadyHealth

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