Can I Have a Spinal Fracture Even If I Have No Pain?

Neil Gonter, MD Health Pro
  • Reader Question: I am 65 years old. I have been having increased difficulty getting things down from high shelves. I saw my primary physician and he told me that I have lost 2 inches of height. He also told me that I may have vertebral (spinal) fractures and should have a bone density to check for osteoporosis. I have no pain. Is this possible?


    No one wants to hear this, but height loss is common with age. Beginning in our early 50s, height begins to normally decrease, often as much as two inches by age 80.
    It is important to first understand the structure of our back. This includes multiple vertebra (bones): seven cervical (neck), twelve thoracic (chest), and five lumbar (lower back) vertebra. Between each vertebra, there is a vertebral disk that acts as the shock absorber of the spine. There are also tough fibrous bands called ligaments that connect the bones and joints, muscles that give the back stability and strength, and tendons that connect the bones to the muscles.

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    Abnormalities within the back structure as well as other parts of the body can lead to height loss. While fractures in the spine (back) can be a cause of height loss, there are other multiple causes for this. Possible reasons include, loss of vertebral disk height from between the vertebra, changes in posture of the back including forward and lateral bending of the spine, narrowing of the hips or/and knees with curvature, and flattening of the arches of the feet.


    Unfortunately, fractures of the spine are extremely common. Only 20-30% of fractures are recognized due to pain or other clinical symptoms. The rest of them are discovered on radiological studies of the region, often done for other reasons. Fractures are important not only due to the pain they cause, but also due to increased death and associated medical problems. The resulting changes in posture can inhibit breathing by inhibiting one's ability to take a deep breath. It can also limit activity, including bending and reaching, and can change the stomach anatomy leading to constipation, swelling, pain, and decreased appetite.


    Importantly, vertebral fractures that are confirmed by radiology studies are an extremely powerful risk factor for further fractures in this region, as well as other regions. Screening by comparing any height loss from one's tallest achieved height is a fast, safe and non-invasive technique. If there is significant loss, one should have x-rays of the spine, or if available, a vertebral fracture assessment (VFA, a side scan of the vertebrae using a bone density machine).


    Finally, as per the National Osteoporosis Foundation guidelines, if one has never had a bone density, it would definitely be an appropriate time to check this.




Published On: September 11, 2008