Compression Fracture of the Spine

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KEY POINTS

• A compression fracture is a collapse of small sections of the bones in your spine. If you have osteoporosis, fractures can happen while making a bed, opening a door, or picking something up from the floor. Sometimes a cough or fall can cause the fracture.
• Treatment may include rest, medicines, a back brace, physical therapy, or surgery.
• Doing what you can to prevent osteoporosis can help prevent compression fractures. Also, try to make your home safe from accidents to prevent falls and injury. Wear shoes that provide good support and use a can or other support for walking if you need it.

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What is a compression fracture of the spine?

A compression fracture is a collapse of small sections of the bones in your spine (vertebrae).

What is the cause?

Compression fractures of the spine are most often caused by osteoporosis, particularly in older adults. Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. It often starts to develop in women after menopause. Men may get the disease later in life, typically in their 70s. Other possible causes of compression fracture are injury, cancer, or infection.

Adults of any age who take steroid medicine, such as prednisone, for a long time have a much higher risk for osteoporosis and compression fracture.

If you have brittle bones, a compression fracture can happen during routine activities, such as making a bed, opening a door, or picking something up from the floor. Sometimes a cough or fall can cause the fracture.

What are the symptoms?

The most common symptom is sudden pain in the lower back or mid-back. The pain may extend throughout your back, hips, and legs. It may get worse when you sit or stand. It can make it hard to move or walk.

You may have a compression fracture without knowing it. It does not always cause severe pain or a change in the way your body works. However, over time, compression fractures may make you shorter by as much as several inches.

In some cases, several compression fractures in the upper part of the back (between the shoulder blades) can lead to kyphosis, which is a rounding of the back that can cause trouble breathing.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• X-rays of the spine
• Bone scan, which uses a small amount of radioactive chemical injected into your blood to make detailed pictures of your bones
• CT scan, which uses X-rays and a computer to show detailed pictures of the spine
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the spine

How is it treated?

A compression fracture of the spine can usually be treated at home. Your healthcare provider may recommend that you:

• Rest in bed for a few days until you have less pain. Staying in bed more than a few days may make your pain worse. Your healthcare provider will recommend activities that you can do safely and let you know how soon you should start them.
• Wear a back brace to make you more comfortable by giving the fractured area support.
• Take pain medicine or medicine to relax your muscles.
• Take medicine to treat osteoporosis.
• Get physical therapy to strengthen back and abdominal muscles.
• Get occupational therapy to help you get and use special equipment such as shower stools and grab bars.

If you have severe pain that is not getting better, your provider may recommend vertebroplasty or kyphoplasty. These procedures inject bone cement into the weakened bones in your spine. This stiffens the vertebrae and helps reduce pain. Kyphoplasty may also restore height.

If the compression fracture is causing the bones of your spine to press onto nearby nerves or your spinal cord, you may need surgery to decompress the nerves. Surgery can also help make the bones of your back stronger and more stable.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup.
• When you feel pain in your back, stop what you are doing and put either heat or cold on your back, depending on which feels better:
  • Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the painful area every 3 to 4 hours for up to 20 minutes at a time.
  • Put a hot water bottle or electric heating pad on your back. Cover the hot water bottle with a towel or set the heating pad on low so you don’t burn your skin.
• Use a cane or walker as directed by your healthcare provider.
• Avoid over-stretching or stooping to prevent further injury.

How can I help prevent compression fractures?

Doing what you can to prevent osteoporosis can help prevent compression fractures. For example:

• Eat a healthy diet. Foods such as low-fat milk and dairy products, green leafy vegetables, citrus fruits, sardines, and shellfish can help you get calcium. Calcium helps your bones stay healthy. Ask your healthcare provider about the best way for you to get the right amount of calcium and vitamin D every day.
• Get regular weight-bearing exercise to help build up bone. Strengthening your muscles as well as your bones can help prevent falls and injury. Ask your healthcare provider if there are any limits on your exercise.
• If you smoke, try to quit. Talk to your provider about ways to quit smoking.
• If you want to drink alcohol, ask your provider how much is safe for you to drink.
• If you take antacids regularly, ask your provider which ones are safe for you to take.
• Get tested regularly for osteoporosis with a DEXA scan. This test is a special X-ray exam of the spine, hip, or wrist.
• Talk to your healthcare provider about other ways to lower your risk of osteoporosis.

Using your body wisely when you do everyday tasks may help prevent compression fractures. For example:

• When lifting heavy objects, bend your legs rather than your back when you pick up something from the floor. Hold objects close to your body when lifting them.
• Avoid sudden increases in vigorous physical activity. Build your activity level slowly.
• Wear shoes that provide good support, such as shoes designed for running or walking.
• Use support for walking, such as a cane, if you need it. When you are getting out of a chair, put your weight over your feet and slide to the front of the chair. Then, using the arms of the chair, raise yourself to a standing position.
• Try to make your home safe from accidents to prevent falls and injury. For example, install handrails in the bathroom and remove loose rugs. Keep items you could trip over--like electric cords, oxygen tubing, clothing, and craft items (like yarn)--off the floor or out of common walking areas.