Spinal Fracture

Causes

  • Osteoporosis
  • Trauma
  • Infections
  • Tumors

Osteoporosis

Osteoporosis is a condition that causes a thinning of the bones. This can result in vertebral compression fractures, deformity (kyphosis) and even death. Osteoporosis and related spine fractures are largely treatable and preventable with  medications, calcium intake, and  kyphoplasty or vertebroplasty surgery.

Spine Compression Fracture

The type of fracture in the spine that is typically caused by osteoporosis is generally referred to as a compression fracture.

A compression fracture is usually defined as a vertebral bone in the spine that has decreased at least 15 to 20% in height due to fracture.

These compression fractures can occur in vertebrae anywhere in the spine, but they tend to occur most commonly in the upper back (thoracic spine), particularly in the lower vertebrae of that section of the spine (e.g. T10, T11, T12). They rarely occur above the T7 level of the spine. They often occur in the upper lumbar segments as well, such as L1.

Types of Fracture

A spinal fracture due to osteoporosis (weak bones) is commonly referred to as a compression fracture, but can also be called a vertebral fracture, osteoporotic fracture, or wedge fracture.

The term “wedge fracture” is used because the fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged. This process results in a wedge-shaped vertebra. A wedge compression fracture is generally a mechanically stable fracture pattern.

Typical Compression Fracture Symptoms

The main clinical symptoms of vertebral fractures typically include one or a combination of the following symptoms:

  1. Sudden onset of back pain
  2. Standing or walking will usually make the pain worse
  3. Lying on one’s back makes the pain less intense
  4. Limited spinal mobility
  5. Height loss
  6. Deformity and disability

Osteoporosis: The Primary Cause of Collapsed Vertebrae

Osteoporosis causes bones to thin and become more brittle and weak. The thinning bones can collapse during normal activity, leading to a spinal fracture. These compression fractures can cause a great deal of pain and can permanently alter the shape and strength of the spine.

Diagnostic Tests

Depending on the physician’s findings from the patient’s history, physical exam, and x-ray, additional diagnostic tests may also be needed, such as:

  1. A CAT scan, to see whether or not the fractured bone is stable and/or to see if the adjacent nerves near the fracture are being irritated or may be affected by the fracture. Because a CAT scan can show soft tissue (e.g. nerves) as well as bone, and because it can take cross-sectional images of the spine, it provides the physician more information than an x-ray.
  2. An MRI scan may be ordered if the doctor suspects that there may be some other cause of the patient’s pain (e.g. a herniated disc), or if there is a chance that nerves near the fracture are affected. An MRI scan shows a high level of detail of the soft tissues (e.g. nerves, discs) surrounding the fracture that may be affected. An MRI scan can also tell if the fracture is old or new. In a new fracture the bone will be particularly dark on one sequence of films (the T1 weighted sagittal images).
  3. A nuclear bone scan may be used to help determine when the fracture occurred. The age of the fracture is sometimes important to know to help guide treatment options.

Osteoporosis is by far the most common cause of vertebral compression fractures, especially in women over the age of 50. It is also more common than most people think in people age 40-50, and it is reasonably common in men over age 50.

Compression Fracture Treatment

Treatment of a spinal fracture caused by osteoporosis is usually two-pronged, including both treatment of the fracture, and treatment of the underlying osteoporosis that led to the fracture.

Fracture treatment

Treatment for the vertebral fracture will typically include non-surgical care, such as rest, pain medication, use of heat or ice for local pain, and slow return to mobility. Surgery may also be advisable. The two most common types of surgery for this type of fracture are vertebroplasty and kyphoplasty. Both types of surgery can help the fracture heal.

  • Vertebroplasty:
    This minimally invasive treatment is designed to help reduce or eliminate pain caused by a fractured vertebra and stabilize the bone. Low viscosity cement is injected directly into the collapsed vertebral body under high pressure, with the goal of stabilizing the fracture and relieving the associated back pain.
  • Kyphoplasty:
    Similar to vertebroplasty, kyphoplasty is a minimally invasive procedure designed to reduce or stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.

Helping prevent future fractures by treating the osteoporosis

After sustaining one vertebral fracture, the patient is at risk for more fractures, so treatment of the patient’s underlying osteoporosis is an important part of the treatment plan.

Osteoporosis treatment will typically include one or a combination of the following: calcium supplements, increased vitamin D, weight-bearing exercises, and hormone replacement therapy for women.

Because of the significant health and deformity risks related to multiple vertebral fractures, it is advisable for patients who suspect their back pain may be from a fracture to get an accurate diagnosis and a pursue a comprehensive treatment plan.

Osteoporosis Treatment and Management

Treatment for osteoporosis typically involves lifestyle changes to diet and exercise, as well as medication that slows down the rate of bone breaking down (called bone resorption), increases bone formation, or both.

If a patient experiences a painful vertebral compression fracture from osteoporosis, they may be a candidate for surgeries such as kyphoplasty or vertebroplasty.

This page provides information on diet, exercise, and fall prevention that can help reduce the risk of complication from osteoporosis.

Diet and Nutrition

It is important for patients with osteoporosis to receive adequate calcium and vitamin D through a healthy, balanced diet. A doctor, nutritionist, or other health professional can educate patients on the amounts of calcium and vitamin D they should receive each day, as well as easy ways to work these nutrients into a daily diet.

Calcium

Most patients are advised to initially increase calcium intake through their diet. Dietary calcium can be found in dairy products such as milk, cheeses, and yogurt. If a patient has restrictions to dairy, a supplement is typically recommended. Other sources of dietary calcium include dark leafy greens (such as spinach, broccoli, and kale) and calcium-fortified foods and juices.

It is not advised to take more calcium than is recommended, either through diet or supplements. Excess calcium may increase the risk for other health problems, such as kidney stones, cardiovascular disease, or stroke.1

Vitamin D

Adequate vitamin D intake is necessary for the body to absorb calcium. Because high levels of vitamin D are not found in many foods, supplements may be advised. The amount of supplemental vitamin D recommended may vary from one osteoporosis patient to another depending on their dietary needs.

It is not uncommon for a doctor to advise vitamin D intake higher than the daily recommended amount of 15 mcg (600 IU) to 20 mcg (800 IU).1 Taking up to 100 mcg (or 4000 IU) per day is considered the safe upper limit.2

Exercise and Fitness

Regular exercise is important to help maintain bone density and provide overall muscle strengthening that can reduce the risk of falls. Weight-bearing exercise and muscle strengthening are especially important for bone health and fall prevention.

Reducing the Risk of Falling

Because osteoporosis causes bones to be thinner and weaker, it is important to reduce the risk of high-impact injuries as much as possible, including falls. There are a few methods that can help reduce the risk of falling:

  • Exercise to strengthen muscles and improve balance and coordination.
  • Make modifications to home safety, such as by installing a handrail in the shower, using a shower stool, or relocating everyday items to the ground floor to reduce the use of stairs.
  • Correct visual impairments that may cause a person to trip and fall.

Additionally, a patient with osteoporosis may work with an occupational therapist for more individualized advice for fall prevention.