Under certain conditions, one or more vertebrae can start to crack under the weight of the spine. This is called a compression fracture.

As unpleasant as it sounds, a compression fracture doesn't have to be a debilitating injury. With proper treatment, most people can either recover completely or keep their symptoms under control.

If your bones are young and healthy, it takes quite a blow to the spinal column to cause a compression fracture. Therefore, compression fractures are most common in people who already have weak bones to begin with.

The bone-thinning disease osteoporosis is by far the leading cause of compression fractures. Some 700,000 Americans suffer osteoporosis-related compression fractures each year, according to a report from the University of Pittsburgh. Once this disease has robbed bones of their natural strength and density, even slight jolts may cause a fracture. People with very advanced osteoporosis can break a vertebra in their spines just by picking up a heavy box. People with milder cases of osteoporosis often suffer compression fractures in minor car accidents or short falls. More rarely, cancer in the bone can be the root cause of a compression fracture -- as the cancer eats away at the bone, the vertebrae collapses. Another common type of osteoporosis occurs in people who have or have had health problems that require them to take corticosteroid medications for a prolonged period of time.

Even healthy vertebrae can buckle under extreme force. If a person falls from a significant height or crashes their car at high speed, compression fractures can be one of their injuries.

Mild compression fractures may go completely unnoticed. Most fractures, however, are impossible to ignore. Depending on the severity of the break, a fracture can cause pain ranging from mild discomfort to agony. The pain may come on suddenly or build slowly. Pain isn't the only possible symptom. If enough vertebrae collapse, the spine will bend forward, creating a hump. This deformity, sometimes called a widow's hump, is common among people with advanced osteoporosis.

Sometimes, a fractured vertebra can press against the spinal cord, causing numbness, tingling, or weakness.

Compression fractures usually show up clearly on simple x-rays. If your doctor suspects osteoporosis, he or she may also want to scan your body with a device that measures bone density. In general, osteoporosis is much more common in women at an earlier age than men. Women typically see symptoms of osteoporosis in their late 60s, while men generally don't experience the same symptoms until their late 70s and 80s.

If the fracture was the result of a serious accident, your doctor may want to take a closer look with a computed tomography (CT) scan. This procedure can detect fragments of bone that may press against the spinal cord. Likewise, your doctor may want to run a CT scan or a magnetic resonance imaging (MRI) test if there's any suspicion of cancer.

Sometimes blood and urine tests are also helpful to determine the cause of the compression fracture, especially if the fracture has occurred unexpectedly and is not caused by age-related osteoporosis. They may help your doctor diagnose other rare diseases that can affect your bones.

With time, the pain from compression fractures caused by osteoporosis usually gets better on its own. Your doctor may suggest a few days of bed rest until your pain starts to fade. You may also need medications to control your pain. For extra protection, your doctor may prescribe calcitonin (Fortical, Miacalcin), a drug that strengthens bones and may also reduce some of the pain, or a bisphosphonate like alendronate (Fosamax), which also strengthens bones. If you've suffered a major trauma, you'll probably need to wear a brace for several weeks until the bone heals. You may also need surgery to stabilize the spine and to remove any bone fragments left in the spinal canal.

A tumor calls for a full evaluation of the causes -- starting with a bone biopsy, and sometimes proceeding on with chemotherapy, radiation therapy, or other cancer-fighting treatment. A drug called Zometa has been shown to reduce complications that come with bone cancer or breast cancer that has spread to the bone. Studies show that Zometa decreases pain and prevents the overall deterioration of the patient's quality of life.

Minimally invasive surgeries can also help people with persistent pain from a compression fracture. Two relatively new procedures -- vertebroplasty and kyphoplasty – are increasingly being used to treat compression fractures in patients that don’t respond to bed rest and medications. In each procedure, a doctor uses a needle to inject a special bone cement between crushed vertebrae. In kyphoplasty, a doctor will also spread the bones apart with a balloon before injecting the cement. Both kyphoplasty and vertebroplasty are performed with a local anesthetic, and the procedures are usually completed in an hour or less.

Because vertebroplasty and kyphoplasty are relatively new, however, some uncertainty remains. In 2002, the FDA warned that leaking bone cement has been known to press against nerves and cause pain. There are also studies showing an increased risk of subsequent fractures following these procedures, particularly kyphoplasty. Be sure to talk to your doctor about all of the pros and cons of the procedures before you agree to treatment. You may want to get opinions from more than one experienced back surgeon before deciding which is best for you. Also, your health insurance may not cover all of these procedures, so be sure to check which ones it will pay for.

The best way to avoid compression fractures is to prevent their number one cause -- osteoporosis. And the best way to do that is to eat a healthy diet rich in calcium and vitamin D, and to exercise regularly. Weight bearing exercise strengthens the bones --even daily activities like carrying your laundry or groceries can be helpful to keep your bones strong. Also, it's important to maintain a healthy weight -- being too thin can reduce your bone density. If you smoke, stop. Smoking interferes with the production of bone cells, according to the American Academy of Orthopaedic Surgeons.

-- Chris Woolston, MS, is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education.

References

Last updated May 15, 2009
Copyright © 2003 Consumer Health Interactive

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