Although compression fractures can occur anywhere along the vertebral column, they are most common at the thoracolumbar junction involving the T8-T12, L1, and L4 vertebrae [1]. The incidence of this condition increases steadily with advancing age [2]. Lumbar compression fractures can be asymptomatic and may be detected incidentally in the elderly on lumbar X-rays or may present insidiously with a backache. The pain is typically in the midline, aching or stabbing in quality, non-radiating and severe enough to cause disability and interfere with activities of daily living. The pain is usually relieved by lying supine and is aggravated by standing or walking. The pain often persists even after the fracture has healed [3]. However young adults with lumbar compression fractures may be diagnosed with a severe back pain of sudden onset and neurologic deficits in the lower limbs following a vehicular accident. The incidence of associated radiculopathy increases with descending spinal levels [4]. In the elderly, multiple fractures over a period of time lead to decrease in height and stature with subsequent paraspinal muscle shortening, lumbar lordosis, and thoracic kyphosis. As a result, the individual has to actively contract the paraspinal muscles to maintain posture leading to fatigue and in severe cases, it can lead to impaired lung function, abdominal protuberance, compression of abdominal organs with early satiety and loss of weight [5].

Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.

• Nightmare

  Unfortunately, that dream holiday became a nightmare. [melioguide.com]

• Noncompliance

  Additional new fractures can be due to the progression of the underlying osteoporosis, especially if the bone mineral density is very poor and the patient is noncompliant with treatment, has another fall or injury, or as a result of secondary effects [cureus.com]

• Constipation

  Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation. Bisphosphonates and calcitonin may be recommended to help your bones get stronger. [drugs.com]

  This symptom can be caused by the shorter spine putting pressure on the stomach leading to stomach and digestive issues such as loss of appetite, constipation and weight loss. [apmhealth.com]

  These fractures can result in other complications, however, such as: Reduced spinal range-of-motion Lung disorders, such pneumonia or a collapsed lung Crowding of internal organs Constipation Bowel obstruction Progressive muscle weakness Deep venous thrombosis [paindoctor.com]

  […] is needed to avoid problems with kidneys and stomach Should not be taken for long periods if possible Opiates (medications related to morphine) These are very strong painkillers Available only on prescription Can cause drowsiness, confusion, falls, constipation [bsir.org]

  Crowding of internal organs Respiratory decrease-atelectasis, pneumonia Prolonged pain Low self-esteem Emotional and social problems Increased nursing home admissions Mortality TABLE 1 Complications from Compression Fractures of the Spine Constipation [aafp.org]

• Back Pain

  METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. [ncbi.nlm.nih.gov]

  It is by this mechanism that abdominal binders provide spinal support and hence relieve back pain. [oandplibrary.org]

  […] allowing defense counsel to urge upon the jury that plaintiff’s new complaints of back pain were related directly to and the result of her prior condition. [newyorkinjurycasesblog.com]

• Low Back Pain

  METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. [ncbi.nlm.nih.gov]

  The majority of low back pain (LBP) is perceived to originate from the lumbar spine; however, another likely source of LBP that is mostly overlooked is the SIJ. [pubfacts.com]

  "Evaluation of low back pain and assessment of lumbar corsets with and without back supports," Ann. of the Rheum. Dis., 40:449 (1981). [oandplibrary.org]

  A Colour atlas of LOW BACK PAIN. F.A. Davis‬‬ Clinical Bottom Line Lumbar compression fractures, whether from trauma, osteoporosis, infection or neoplasm, occur often enough to be worthy of adequate research with focus on healing procedures. [physio-pedia.com]

• Spine Pain

  Doctors also check for other injuries, such as heel fractures and additional fractures in the spine. [merckmanuals.com]

  At the time of discharge, the patient had minimal thoracic spine pain and trace lower extremity edema. [casesjournal.biomedcentral.com]

• Loss of Lumbar Lordosis

  The change in shape of the vertebral body after a fracture may result in a visible focal increase in kyphosis or loss of lumbar lordosis.12,26,27 Multiple OVCFs can lead to a noticeable loss of height and a further accentuation in postural change.9,12 [ncbi.nlm.nih.gov]

• Urinary Retention

  Symptoms of a spine injury in the thoracic, lumbar and sacral regions can include: Neck or back pain, especially when moved Tenderness Numbness Tingling or a pricking sensation of the skin Paralysis Urinary or fecal incontinence Urinary retention To diagnose [chop.edu]

  Losing control ( incontinence ) of urine or stool or inability to urinate (urinary retention): If these symptoms are present, the fracture may be pushing on the spinal cord itself. [emedicinehealth.com]

  However, narcotics have significant side effects, including reduced gastrointestinal motility, urinary retention, reduced respiratory drive and cognitive deficits, with loss of balance, increase of falls and depression. 64 In addition, muscle relaxants [bmb.oxfordjournals.org]

Lumbar compression fracture should be suspected in postmenopausal women and the elderly who present with sudden onset severe lumbar pain. Many patients may remember a specific injury [6] although the condition may present without any prior history of trauma. Tenderness is typically elicited on palpating directly over the fracture site and there may also be kyphosis [7]. A thorough neurological examination is necessary but may not reveal any deficits in uncomplicated fractures.

Plain X-rays of the spine will confirm the diagnosis and reveal the classic wedge deformity corresponding to the site of maximum tenderness. A reduction in vertebral height by 20% or a decrease of at least 4 mm compared to the baseline height is an indication of a compression fracture [6]. Ideally, the entire spine should be imaged to exclude multiple fractures and occasionally serial imaging may be required to detect the fracture.

Techniques like computed tomography (CT), magnetic resonance imaging (MRI) help in diagnosis by excluding the other etiologies of back pain. They also confirm the integrity of the posterior vertebral wall [8]. In addition, a CT can detect a compression fracture (not visualized on plain radiographs), spinal canal narrowing and differentiate between a compression fracture and a burst fracture. An MRI is indicated in patients with neurologic deficits, or if a malignancy is suspected as the underlying cause of the lumbar compression fracture. Positron emission tomography (PET) can also be ordered to differentiate between compression fractures of benign versus malignant etiology.

Laboratory tests like erythrocyte sedimentation rate, complete blood count (CBC), prostate-specific antigen testing, serum protein electrophoresis to exclude multiple myeloma and urinalysis for Bence-Jones proteins should be routinely performed. Bone density scanning is recommended to measure the severity of osteoporosis and for further patient management [9].

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2. Melton LJ 3d, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;129:1000–11.
3. American Geriatrics Society. The management of chronic pain in older persons: AGS panel on chronic pain in older persons. J Am Geriatr Soc. 1998;46: 635–51.
4. Kim DE, Kim HS, Kim SW, Kim HS. Clinical analysis of acute radiculopathy after osteoporotic lumbar compression fracture. J Korean Neurosurg Soc. 2015 Jan; 57 (1):32-5.
5. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13Suppl 2: S27–31.
6. Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800.
7. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299–308.
8. Predey TA, Sewall LE, Smith SJ. Percutaneous vertebroplasty: a new treatment for vertebral compression fractures. Am Fam Physician. 2002;66:611–5.
9. Ullom-Minnich P. Prevention of osteoporosis and fractures. Am Fam Physician. 1999;60:194–202.