Bone loss in the spine takes place rapidly around the time of menopause. As a result, the vertebrae can weaken, leading to compression fractures; an estimated 25 percent of American women over age 50 experience one or more compression fractures of their vertebrae in their lifetime. Men account for approximately one-seventh of the vertebral compression fractures associated with osteoporosis.
Compression fractures in people with weakened vertebrae are usually caused either by falling or by placing a load on outstretched arms (for example, by raising a window or lifting a small child or bag of groceries). Such spinal fractures typically cause the front of the vertebrae to collapse.
A vertebral compression fracture due to osteoporosis is accompanied by intense, localized back pain in about 80 percent of cases, although there may be no pain until a few days after the fracture.
When pain develops, it can be severe enough to incapacitate a person for several weeks. Pain worsens during activities that involve twisting or bending and initially does not ease up, even with bed rest.
Typically, the pain will resolve after several weeks with the use of mild analgesics and rest. The pain may continue and get worse, however, if the bone fails to heal because of a loss of blood supply or if the vertebral deformity that results from the fracture either accelerates degenerative changes in the facet joints or compresses a nerve root.
A frequent problem immediately following a fracture in the lower lumbar region is difficulty with urination and bowel movements. Fortunately, this is temporary.
Longer-term repercussions include stooped posture and loss of height. These structural changes reduce the space available for vital organs such as the stomach and lungs. Compression of the stomach causes the abdomen to protrude and creates a sensation of indigestion or fullness that may lead to weight loss, while compression of the chest cavity leads to a reduction in lung capacity that can contribute to breathlessness or lung disease.
Structural changes caused by vertebral compression fractures also weaken the spinal extensor muscles, leading to fatigue. They can also cause concerns about physical appearance and make it hard to find clothes that fit properly.
All of these problems may lead to depression as well as difficulty sitting or sleeping. Rarely, a severe vertebral collapse may cause paralysis by exerting pressure on the spinal cord.
The best treatments
If you’re under age 70, conservative treatment is typically recommended, consisting of bed rest, analgesics, and nonsteroidal anti-inflammatory drugs (NSAIDs), use of a brace, and physical therapy. But if you are over 70, a minimally invasive surgery called percutaneous vertebroplasty may be a better option.
Studies comparing conservative treatment and vertebroplasty have had mixed results. But older age may make it more likely that conservative treatment won’t work—at which point vertebroplasty is often recommended.
To test the idea that vertebroplasty might be more effective if performed first, in the early weeks after a fracture, researchers studied 135 patients over age 70 who were recently diagnosed with a vertebral compression fracture. The findings, which were reported in 2016 in Spine, showed that when performed within an average of about eight days of a fracture, vertebroplasty led to better and faster pain relief with fewer complications than conservative treatment. The benefits were maintained at one year after surgery.
Similar results were reported in 2016 in The Lancet. This Australian study of 120 patients demonstrated pain reduction benefits from vertebroplasty when the procedure was performed less than six weeks after a fracture.
Although more studies are needed to confirm these results, ask your doctor if vertebroplasty might benefit you.
Learn about alternative therapies for back pain.