Compression Fractures

What you need to know

During the aging process, the bones in the body begin to thin and weaken. This condition is called osteoporosis. Small micro fractures occur in the weakened bone, which eventually add up and cause the vertebra to collapse. This is called an insufficiency compression fracture .

Women over the age of 50 are susceptible to these issues from menopause. The decreased estrogen causes increased breakdown of the bony tissue, making the bones extremely brittle unable to support the weight of the spinal column. Caucasion and Asian women, thin women, and smokers are at increased risk.
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The majority of compression fractures compress the front of the vertebra and instead of maintaining a square shape, create a wedge shape vertebra. If a patient sustains enough of them, their posture changes to being severely stooped and they develop kyphosis or gibbus deformity. This is called a Dowager’s hump.

Patients are usually first diagnosed by performing plain x rays which show collapse of the vertebra. The acuity is usually demonstrated by performing a MRI which also can show if any bone is pushed into the back of the spinal canal compressing the spinal cord or any nerves. A CT scan can be performed in the event an MRI cannot be obtained.
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Patients who sustain these injuries are usually recommended to undergo a bone density test to assess the severity of the osteoporosis. They are further encouraged to begin bisphosphonate therapy which can be administered by mouth (actonel, fosamax, boniva) or intravenously.
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Acute fractures can be treated with various braces such as a thoracolumbar orthosis (TLSO) and analgesics to decrease the symptoms. Patients who fail conservative care for the first 6-8 weeks may become candidates for a minimal invasive vertebral body augmentation, ie, kyphoplasty.