Compression Fractures

Under certain conditions, one or more vertebrae can start to crack under the weight of the spine. This is called a compression fracture.

As painful as it is, a compression fracture doesn't have to be a debilitating injury. With proper treatment, most people can either recover completely or keep their symptoms under control.

What causes compression fractures?

If your bones are young and healthy, it takes quite a blow to the spinal column to cause a compression fracture. Therefore, compression fractures are most common in people who already have weak bones to begin with.

The bone-thinning disease osteoporosis is by far the leading cause of compression fractures. Some 700,000 Americans suffer osteoporosis-related compression fractures each year, according to a report from the University of Pittsburgh. Once this disease has robbed bones of their natural strength and density, even slight jolts may cause a fracture. People with very advanced osteoporosis can break a vertebra in their spines just by picking up a heavy box. People with milder cases of osteoporosis often suffer compression fractures in minor car accidents or short falls.

More rarely, cancer in the bone can be the root cause of a compression fracture -- as the cancer eats away at the bone, the vertebrae collapses. Another common type of osteoporosis occurs in people who have or have had health problems that require them to take corticosteroid medications for a prolonged period of time.

Even healthy vertebrae can buckle under extreme force. If a person falls from a significant height or crashes their car at high speed, compression fractures can be one of their injuries.

What are the symptoms of compression fractures?

Mild compression fractures may go completely unnoticed. In fact, in 2010 the International Osteoporosis Foundation declared that two-thirds of them go undiagnosed and untreated. "Doctors must look out for evidence of spinal fractures, especially in their patients over 50 -- stooped back, loss of height, and sudden, severe back pain are the three tell-tale signs," Harry K. Genant, of the University of California, said in a news release accompanying the report.

Most fractures, however, are impossible to ignore. Depending on the severity of the break, a fracture can cause pain ranging from mild discomfort to agony. The pain may come on suddenly or build slowly. Pain isn't the only possible symptom. If enough vertebrae collapse, the spine will bend forward, creating a hump. This deformity, sometimes called a widow's hump, is common among people with advanced osteoporosis.

Sometimes, a fractured vertebra can press against the spinal cord, causing numbness, tingling, or weakness.

How are compression fractures diagnosed?

Compression fractures usually show up clearly on simple x-rays. If your doctor suspects osteoporosis, he or she may also want to scan your body with a device that measures bone density. In general, osteoporosis is much more common in women at an earlier age than men. Women typically see symptoms of osteoporosis in their late 60s, while men generally don't experience the same symptoms until their late 70s and 80s.

If the fracture was the result of a serious accident, your doctor may want to take a closer look with a computed tomography (CT) scan. This procedure can detect fragments of bone that may press against the spinal cord. Likewise, your doctor may want to run a CT scan or a magnetic resonance imaging (MRI) test if there's any suspicion of cancer.

Sometimes blood and urine tests are also helpful to determine the cause of the compression fracture, especially if the fracture has occurred unexpectedly and is not caused by age-related osteoporosis. They may help your doctor diagnose other rare diseases that can affect your bones.

What is the treatment for compression fractures?

With time, the pain from compression fractures caused by osteoporosis usually gets better on its own. Your doctor may suggest a few days of bed rest until your pain starts to fade. You may also need medications to control your pain. For extra protection, your doctor may prescribe calcitonin (Fortical, Miacalcin), a drug that strengthens bones and may also reduce some of the pain, or a bisphosphonate like alendronate (Fosamax), which also strengthens bones.

If you've suffered a major trauma, you'll probably need to wear a brace for several weeks until the bone heals. You may also need surgery to stabilize the spine and to remove any bone fragments left in the spinal canal.

A tumor calls for a full evaluation of the causes -- starting with a bone biopsy, and sometimes proceeding on with chemotherapy, radiation therapy, or other cancer-fighting treatment. Drugs called bisphophonates have been shown to reduce complications that come with breast cancer that has spread to the bone. Studies show that it decreases pain, slows bone erosion and prevents the overall deterioration of the patient's quality of life.

Minimally invasive surgeries can also help people with persistent pain from a compression fracture. Two procedures -- vertebroplasty and kyphoplasty -- have been increasingly used to treat compression fractures in patients that don't respond to bed rest and medications. In each procedure, a doctor uses a needle to inject a special bone cement between crushed vertebrae. In kyphoplasty, a doctor will also spread the bones apart with a balloon before injecting the cement. Both kyphoplasty and vertebroplasty are performed with a local anesthetic, and the procedures are usually completed in an hour or less.

Because vertebroplasty and kyphoplasty are relatively new, however, some uncertainty remains. The FDA warned that leaking bone cement has been known to press against nerves and cause pain. There are also studies showing an increased risk of subsequent fractures following these procedures, particularly kyphoplasty. In addition, a small study reported in the New England Journal of Medicine in 2009 found that at least in the short term, vertebroplasty did not work any better than a sham procedure.

Because the success of the procedures has been challenged, be sure to talk with your doctor about the pros and cons of the procedures before you agree to treatment. You may want to get opinions from more than one experienced back surgeon before deciding which is best for you. Also, your health insurance may not cover all of these procedures, so be sure to check which ones it will pay for.

Is there anything I can do to protect myself?

The best way to avoid compression fractures is to prevent their number one cause -- osteoporosis. And the best way to do that is to eat a healthy diet rich in calcium and vitamin D, and to exercise regularly. Weight bearing exercise strengthens the bones --even daily activities like carrying your laundry or groceries can be helpful to keep your bones strong. Also, it's important to maintain a healthy weight -- being too thin can reduce your bone density. If you smoke, stop. Smoking interferes with the production of bone cells, according to the American Academy of Orthopaedic Surgeons.

-- Chris Woolston, MS, is a health and medical writer with a master's degree in biology. He was the staff writer at Hippocrates, a magazine for physicians, and he has covered science issues for Time Inc. Health, WebMD, Los Angeles Times and the Chronicle of Higher Education.

References

International Osteoporosis Foundation, news release, 2010

Jan de Beur, Suzanne M., M.D. and Riley, Lee H., M.D. 2010 Johns Hopkins White Paper on Back Pain and Osteoporosis. Johns Hopkins Medicine, Baltimore, Maryland, 2010.

Osteoporosis and Spinal Fractures. American Academy of Orthopaedic Surgeons. May 2010.

New England Journal of Medicine, September 2009.

Frankel, BM, Monroe, T, Wang, C. Percutaneous vertebral augmentation: An elevation in adjacent level fracture risk in kyphoplasty as compared with vertebroplasty. Spine. Sep-Oct 2007; 7(5): 575-82.

National Institute for Clinical Excellence. Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. January 2005.

Institute for Myeloma and Bone Cancer Research. Clinical Benefit of Bisphosphonates for Cancer Patients with Metastatic Bone Disease (2005). James R. Berenson.

U.S. National Library of Medicine. Medical Encyclopedia. Compression fractures of the lower back. June 2002.

Mayo Clinic in Jacksonville. News release: pain relief procedure for spinal compression fractures can correct widow's hump deformity as well. August 29, 2002.

University of Pittsburgh. Department of Neurological Surgery. Vertebral compression fractures. 2003.

American Family Physician. Information from your family doctor: Vertebroplasty for spine fracture pain.

Food and Drug Administration. Complications related to the use of bone cement in vertebroplasty and kyphoplasty procedures. October 2002.

Bones take the heat from cigarette smoke. Orthopaedics Update 2001. The American Academy of Orthopaedic Surgeons.

Osteoporosis and compression fractures. Harvinder S. Sandhu, MD, and Mary Claire Walsh. http://www.spineuniverse.com/displayarticle.php/article323.html

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