Spinal compression fracture is the most prevalent form of osteoporotic fractures and is particularly a concern in women of advanced age [1] [2] [3]. Specifically, osteoporosis is the leading cause of vertebral compression fractures [2] [4]. The vertebrae most frequently affected are located in the middle section of the thoracic region and the thoracolumbar junction [1] [5]. Predisposing factors for these compression fractures include older age, Caucasian background, female gender, personal and family history of fractures, vulnerability to falls, etc [2]. Among the modifiable predisposing factors are the use of tobacco and alcohol, nutritional deficiencies in calcium and vitamin D, low weight, sedentary lifestyle, estrogen deficiency, and so forth [2].

Vertebral compression fractures in individuals with severe osteoporosis may stem from smaller traumas [2]. With regards to the clinical presentation, patients with osteoporotic fractures frequently exhibit a distinct appearance characterized by kyphosis and height reduction [2] [6]. Mild fractures are typically asymptomatic or slightly symptomatic in nature. In contrast, severe fractures lead to excruciating pain, subsequent loss of independence and mobility, and hindrance of carrying out normal daily functions [2]. Furthermore, this pain is worsened by various movements. Some may experience pain later and others discover their fractures incidentally on radiographs.

Vertebral compression fractures may also be a consequence of major traumas such as a car accident. Patients with these fractures experience non-radiating acute pain. If spinal cord injury is present, weakness or numbness of the lower extremities is frequently reported.

Compression vertebral fractures are associated with significant morbidity, greater mortality rates [7], and increased risk for subsequent fractures [8]. Depression and emotional hurdles are also common in these patients.

In patients with acute pain, findings are remarkable for tenderness to palpation at the site of the fracture [9]. Neurologic exam is usually normal along with a negative straight leg test unless a spinal cord injury occurred [2].

• Falling

  A spinal compression fracture also may be caused by trauma to the spine such as a car accident, a hard fall, a fall from a height of more than 15 feet landing on the feet, or a blow to the head. [moveforwardpt.com]

  […] numbness, tingling, or weakness (which increases the risks of falling and breaking other bones) Diagnosis Our comprehensive diagnostic process includes: Medical history. [coloradospineinstitute.com]

  Spinal fractures due to osteoporosis often occur while a person is doing something that causes relatively minor trauma to the spine, such as opening a window, suffering an insignificant fall or twisting while lifting. [cedars-sinai.edu]

• Difficulty Climbing Stairs

  She also notes that she has more difficulty climbing stairs than ever before, and that she even has trouble getting up from her chair. Her physical therapist performs an evaluation of her spine. [moveforwardpt.com]

• Impaired Balance

  Compression fractures, if untreated, can lead to curvature of the spine, which can impair balance and overall activity levels. [consumer.healthday.com]

• Chest Pain

  Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. [northshore.org]

  You feel lightheaded, short of breath, and have chest pain. You cough up blood. Your arm or leg feels warm, tender, and painful. It may look swollen and red. You have new problems urinating or having bowel movements. [drugs.com]

• Back Pain

  In patients with osteoporosis and vertebral compression fractures, osteomyelitis should be considered when there is severe back pain, persistent unexplained fever, unexplained elevation of the erythrocyte sedimentation rate, or bacteremia without an obvious [ncbi.nlm.nih.gov]

  Instead, the patient's pain is often just thought of as general back pain — such as from a muscle strain or other soft-tissue injury — or as a common part of aging. [cedars-sinai.edu]

  A common symptom of spinal compression fractures is back pain. But many of these fractures are never diagnosed because patients think back pain is a regular sign of aging and don’t seek treatment. [upmc.com]

  Symptoms Sudden onset of back pain, out of proportion to the activity at hand, may indicate a compression fracture. [stiebermd.com]

• Upper Back Pain

  See Thoracic Spine Anatomy and Upper Back Pain This article provides in-depth information on vertebral compression fractures, including symptoms, diagnosis, and treatments. [spine-health.com]

  You can read more about it in the page upper back pain with breathing. People with advanced postural kyphosis can avoid getting to the sad juncture of spontaneous fracturing by doing their own thoracic spine decompression on a daily basis. [simplebackpain.com]

• Spine Pain

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

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

• Hip Pain

  Children's who sustain multiple compression fractures may have hunch back (kyphosis or "dowager's hump"), gastrointestinal problems, hip pain, and shortness of breath. [oamortho.com]

  Spinal Compression Fractures Facts & Information Pain from untreated SCF can lead to unremitting back and hip pain. [treatingpain.com]

  Spinal column shortening, may cause hip pain, from the ribs resting atop of the pelvis, or gastrointestinal dysfunction with bulging of the abdomen. [painteamrva.com]

• Muscle Swelling

  The cold water helps to reduce muscle swelling and pain since it will numb the area for some time. 4. Aqua therapy : This is gentle exercise done in a pool. [healthcentral.com]

• Impulsivity

  […] vertebral compression fractures by inflating a balloon to restore bone height then injecting bone cement into the vertebral body. spinal cord : part of the central nervous system enclosed and protected by the spinal vertebrae; conducts messages, or impulses [mayfieldclinic.com]

  This in turn can cause interruption of nerve impulses and loss of height. [saveourbones.com]

Patients with back pain suspected to have spinal fractures should be stabilized and examined thoroughly. Eliciting a complete history is paramount and must include any details about falls or other trauma, personal and family history of fractures, and assessment of other risk factors.

Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) are among the important laboratory tests. Additionally, a prostate-specific antigen (PSA) level is indicated in older males. Urine testing may be part of the workup for osteoporosis. Finally, patients suspected for malignancies such as multiple myeloma warrant further testing.

Plain radiography (anteroposterior and lateral views) is the diagnostic imaging modality on which a spinal compression fracture appears as a wedge-shaped deformity [2] [10]. In addition to the wedging, findings indicative of osteoporotic spinal fractures include shortened vertebral height, reduced radiodensity, and trabecular structure loss. Note that the whole length of the spine should be imaged to assess for the presence of other fractures [2].

Patients with neurologic manifestations require magnetic resonance imaging (MRI) for detailed assessment of the spine, especially if compression of the spinal cord is suspected. MRI and computed tomography (CT) are crucial studies for evaluation and exclusion of other etiologies [11]. Additionally, CT scanning provides information on complex fractures.

Also, the clinician should perform bone density tests to assess the individual's degree of osteoporosis and probability of further fractures in the future [12]. A positron emission tomography (PET) scan could be obtained if malignancy is suspected.

A vertebral biopsy may be required if cancer is suspected.

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