Compression Fracture

Sometimes the bones or vertebrae of the spine can crack and collapse under their weight. This is known as a compression fracture, vertebral compression fracture, or VCF. There are almost 1 million compression fractures every year, usually because the bones become weakened and crack under the weight of the vertebrae above them. These fractures can cause spinal weakness affect posture and the ability to stand up straight. They are often the cause for individuals to hunch over, also called kyphosis.

Compression Fracture

Compression fractures are small breaks or cracks in the vertebrae. The breaks occur in the vertebral body, the thick rounded part on the front of each vertebra. These fractures cause the spine to weaken and collapse. With time, these fractures affect posture as the spine curves forward. The fractures are often found in the middle/thoracic spine in the lower area. They often result from osteoporosis but can also happen after a trauma like an automobile accident, work, sports injury, or a tumor on the spine.

Symptoms

Compression fracture symptoms range from mild to severe or no symptoms. Many individuals can stand or walk without pain. They are often discovered when X-rays are taken for another condition. Symptoms include:

• Back pain can come on suddenly and last for a significant time, often diagnosed as chronic back pain.
• It usually develops between the shoulders and the lower back.
• The pain and discomfort decrease when lying down and worsen when standing or walking.
• Decreased mobility or flexibility in the spine. Individuals are unable to twist or bend.
• Hunched over appearance, known as dowager’s hump or hunchback.
• Loss of height from the vertebrae compression and the spine curving.
• Pinched nerves
• Nerve damage can cause tingling, numbness, and difficulty walking.
• Loss of bladder or bowel control with severe, untreated fractures.

Individuals At Risk

• Individuals who have had a compression fracture are more likely to have another one.
• Women over 50 have a higher risk due to osteoporosis.
• With age, the risk increases for men and women.

Diagnosis

A doctor will perform an examination and ask about symptoms. The exam will include:

• Checking spinal alignment.
• Posture analysis.
• Gently palpates different areas of the back to identify the source of pain.
• Examine for signs of nerve damage that include numbness, tingling, or muscle weakness.

A doctor will order imaging studies to examine the backbones, muscles, and soft tissues. Imaging studies include:

• CT scan, X-ray, or MRI of the spine.
• DEXA scan is a type of X-ray that measures bone loss bone density.
• A myelogram is a procedure used along with imaging studies. A contrast dye is injected into the spine before the scan making the images easier to see.
• A triple-phase bone scan is an imaging study that takes three sets of pictures.

Treatment

Compression fracture treatment focuses on relieving pain, stabilizing the vertebrae, and ongoing fracture prevention. Treatment depends on the severity of the fracture and the individual’s overall health. Treatment can include:

Pain Medication

• A doctor can recommend over-the-counter non-steroidal anti-inflammatory medication.
• A doctor may prescribe muscle relaxers or prescription medication.
• Follow instructions carefully when taking medications.

Back Brace

• A special type of back brace helps to support the vertebrae.
• The brace can also relieve pain by reducing how much the spine moves.

Strengthening Meds

• Medications known as bisphosphonates can help slow down bone loss, stabilize the bones and prevent fractures.
• These medications include ibandronic acid and alendronic acid.

Vertebroplasty or Kyphoplasty

• This minimally invasive procedure relieves pain, stabilizes the bones, and improves mobility.
• During vertebroplasty, the doctor inserts a needle in the vertebra and injects bone cement.
• During kyphoplasty, the doctor inserts an inflatable device that they fill with cement.
• Both are outpatient procedures allowing the individual to go home the same day.

Individuals over 65 or that have osteoporosis or a history of cancer are recommended to see their doctor. Individuals who present with sudden back pain that doesn’t get better after a day or two are advised to see a doctor and evaluate for back pain so the doctor can determine the cause and develop a treatment plan.

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Body Composition

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Vitamin D To Build Muscle

Skeletal Muscle Mass decreases as the body ages, primarily due to decreased physical activity. Vitamin D has been reported to influence muscle quality. This could be helpful for adults as they age. Muscle loss diminishes functional performance on activities that require strength and coordination. When this loss of muscle mass becomes significant, it becomes a condition known as sarcopenia. Treatments include:

• Healthy diet
• Exercise
• Vitamin D supplementation
• All were found to slow down muscle loss and help regain muscle mass and strength.
• Vitamin D supplementation is effective, especially in older adults whose blood levels are low.

References

American Academy of Orthopaedic Surgeons. Osteoporosis and Spinal Fractures. (https://orthoinfo.aaos.org/en/diseases–conditions/osteoporosis-and-spinal-fractures/) Accessed 10/25/2021.

American Association of Neurological Surgeons. Vertebral Compression Fractures. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures) Accessed 10/25/2021.

Bischoff-Ferrari, H A et al. “Vitamin D receptor expression in human muscle tissue decreases with age.” Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research vol. 19,2 (2004): 265-9. doi:10.1359/jbmr.2004.19.2.265

Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448171/

Hassan-Smith, Zaki K et al. “25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression.” PloS one vol. 12,2 e0170665. 15 Feb. 2017, doi:10.1371/journal.pone.0170665

McCarthy, Jason, and Amy Davis. “Diagnosis and Management of Vertebral Compression Fractures.” American family physician vol. 94,1 (2016): 44-50.