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]

  Predisposing factors for these compression fractures include older age, Caucasian background, female gender, personal and family history of fractures, vulnerability to falls, etc. [symptoma.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]

• Chest Pain

  Symptoms of a heart attack may include: Chest pain or pressure, or a strange feeling in the chest. Sweating. Shortness of breath. Nausea or vomiting. [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

  The main clinical symptoms of vertebral fractures typically include one or a combination of the following: Sudden onset of back pain Worse pain while standing or walking Less intense pain while lying on one's back Limited spinal mobility Height loss Deformity [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]

  The main clinical symptoms of VCFs may include any of the following, alone or in combination: Sudden onset of back pain An increase of pain intensity while standing or walking A decrease in pain intensity while lying on the back Limited spinal mobility [aans.org]

• Upper Back Pain

  They often occur in the upper lumbar segments as well, such as L1. 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]

  It can also be the source of great pain in the upper back and around the sides and front of the chest wall. Advanced thoracic kyphosis is a common cause of breathing difficulties and pain associated with breathing. [simplebackpain.com]

• Spine Pain

  Symptoms Sudden onset severe back pain Dull, achy back pain or pain that travels around the rib cage Pain down an arm or leg Pain when standing, walking, bending, or twisting Loss of height Forward curvature of the spine Declining ability to function [treatingpain.com]

  If fractures occur in the lower spine, wearing a brace is sometimes recommended to relieve pain and make walking less painful. How effective bracing is unclear. Sometimes bed rest is needed for a few days. [msdmanuals.com]

  Case presentation A 49 year-old Caucasian male presented with progressively worsening pain in the thoracic spine for 10 days and painful bilateral lower extremity edema. [casesjournal.biomedcentral.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.

When conservative treatment options have proven ineffective, two minimally invasive procedures, called vertebroplasty and kyphoplasty, may be considered as treatment options. [aans.org]

Some may need further treatment, such as surgery. Nonsurgical Treatment for Spinal Compression Fractures Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. [webmd.com]

Treatment Options Conservative Treatment The conservative treatment modalities for compression fractures include pain medications, rest, and use of braces or back support. [drscotmiller.com]

Treatment Treatment of compression fractures comprises of non-surgical and surgical treatment options. The non–surgical treatment options include activity modification, use of pain medications and braces. [alvineortho.com]

Treatment and prognosis Management options include: non-surgical observation/bracing medications: bisphosphonates for osteoporosis surgical vertebroplasty [radiopaedia.org]

Outlook (Prognosis) Most compression fractures from trauma will heal in 8 - 10 weeks with rest, bracing, and pain medications. Recovery time will be many weeks longer if surgery is necessary. [gatewaypain.com]

[…] bladder Severe pain, numbness, or weakness High fever While a diagnosis can usually be made through history and a physical examination, plain x-rays, computed tomography (CT) or magnetic resonance imaging (MRI) can help in confirming diagnosis, predicting prognosis [aans.org]

Outlook (Prognosis) Most compression fractures due to injury heal in 8 to 10 weeks with rest, wearing of a brace, and pain medicines. However, recovery can take much longer if surgery was done. [mountsinai.org]

MRI and computed tomography (CT) are crucial studies for evaluation and exclusion of other etiologies. Additionally, CT scanning provides information on complex fractures. [symptoma.com]

Patients with continuing severe pain should be evaluated for other pathologic etiologies of the fracture, especially malignancy or myeloma. [courses.washington.edu]

Often the patient will prefer to stand - reducing the axial load on the spine - instead of sitting. 1 If the patient is older than age 40, it is important to rule out pathologic weakening of the bone as an underlying etiology to the compression deformity [dynamicchiropractic.com]

[…] of Vertebral Compression Fractures of the Spine The most common etiology of VCFs is osteoporosis, although trauma, 12 infection, and neoplasm can also lead to VCFs. 13, 14 Postmenopausal women have the greatest risk because of hormonal changes that can [ncbi.nlm.nih.gov]

Epidemiology of Vertebral Fractures. J Clin Densitom. Jan-Mar 2016;19(1):8-22. Kevin Phan, Prashanth J Rao, Ralph J Mobbs. [danielebarnabei.it]

Riggs, B.L., Melton L.J. 3rd, "The worldwide problem of osteoporosis: insights afforded by epidemiology," Bone, 1995, 17(5 Suppl): p. 505S-511S. Melton L.J. 3rd., "Epidemiology of spinal osteoporosis," Spine, 1997;22:2S-11S. [spine-health.com]

Epidemiology and outcomes of osteoporotic fractures. Lancet 2002 ;359:1761-1767. Based on company data/sales estimates. [stopspinalfracturepain.com]

Nielsen OS, Munro AJ, Tannock IF, Bone metastases: pathophysiology and management policy, J Clin Oncol, 1991;9:509–24. Koenders PG, Beex LV, Kloppenborg PW, et al., Human breast cancer: survival from first metastasis. [touchoncology.com]

These worries are not unfounded, because there is a substantial risk of subsequent fractures of all types and further morbidity in persons who have had a vertebral compression fracture. 9 Pathophysiology and Risk Factors Vertebral compression fractures [aafp.org]

This review provides information on the pathogenesis and pathophysiology of compression fractures, as well as clinical manifestations and treatment options. [ncbi.nlm.nih.gov]

Prevention Spinal compression fractures may be prevented by: preventing the onset of osteoporosis compliance with osteoporosis treatment programs wearing your seat belt and driving safely maintaining an active lifestyle which includes weight bearing activities [mgo.md]

This is a critical part of treatment to help prevent further compression fractures. [webmd.com]

During these surgical procedures, the surgeon injects a cement mixture into the fractured bone to stabilize the fracture, treat pain, and prevent a spinal deformity from progressing. [columbianeurosurgery.org]

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