What are Osteoporotic Spinal Fractures?

Osteoporotic spinal fractures are fractures in the spine caused by weakened bone from osteoporosis or low bone density. These fractures often involve collapse or loss of height in a vertebra, which is one of the bones that make up the spine.

Osteoporotic spinal fractures are also called osteoporotic vertebral compression fractures or osteoporotic compression fractures. They most often affect the thoracic spine or lumbar spine. A fracture may cause sudden back pain, height loss, posture changes, or forward spinal curvature called kyphosis.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed osteoporotic spinal fractures when symptoms suggest persistent pain, progressive vertebral collapse, spinal deformity, instability, nerve compression, spinal cord compression, or another spine-related concern that may require neurosurgical review.

Common Signs and Symptoms

Osteoporotic spinal fracture symptoms depend on the fracture location, fracture age, degree of vertebral collapse, spinal alignment, and whether nerves or the spinal cord are affected.

Common signs and symptoms may include:

• Sudden mid back pain or low back pain
• Pain after a minor fall, twist, lift, cough, sneeze, or routine activity
• Pain that worsens with standing, walking, bending, lifting, or twisting
• Pain that improves when lying down in some patients
• Tenderness over the affected spinal level
• Muscle spasms or stiffness
• Reduced ability to stand upright
• Reduced spinal mobility
• Loss of height over time
• Rounded or forward-bent posture
• Kyphosis, sometimes described as a hunched posture
• Difficulty walking or performing daily activities because of pain
• Numbness, tingling, weakness, or walking difficulty if nerve or spinal cord compression is present
• Bowel or bladder changes in severe cases involving nerve compression

Seek urgent medical evaluation for back pain after a fall, severe or worsening pain, progressive weakness, worsening numbness, trouble walking, loss of coordination, numbness in the groin or saddle area, new bowel or bladder problems, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

Osteoporotic spinal fractures occur when weakened vertebrae cannot tolerate normal or increased stress. In osteoporosis, bones lose density and strength, making them more likely to fracture.

Possible causes and related factors may include:

• Osteoporosis, which weakens bone and increases fracture risk
• Osteopenia, or low bone density that is less severe than osteoporosis
• Advanced age
• Prior vertebral compression fracture
• Low-trauma falls or minor injuries
• Lifting, bending, twisting, coughing, or sneezing in patients with fragile bones
• Long-term corticosteroid use in selected patients
• Low calcium or vitamin D levels in selected patients
• Postmenopausal bone loss
• Low body weight or reduced muscle support in selected patients
• Smoking or alcohol use that may affect bone health
• Family history of osteoporosis or fragility fracture
• Medical conditions that affect bone strength or mineral balance
• Reduced mobility or deconditioning
• Spinal alignment changes, including kyphosis or scoliosis, that alter spinal loading

These causes and risk factors do not mean every patient with osteoporosis will develop a spinal fracture. Treatment planning depends on the fracture location, fracture age, pain severity, neurological examination, bone density, imaging findings, medication history, and overall health.

How It Is Diagnosed?

Osteoporotic spinal fractures are diagnosed through medical history, physical examination, neurological examination, and imaging. Testing also helps determine whether a fracture is new or old, stable or unstable, and related to osteoporosis or another condition.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain onset, fall or injury history, osteoporosis history, medication use, prior fractures, cancer history, and red-flag symptoms
• Physical examination to evaluate posture, tenderness, spinal alignment, range of motion, muscle spasm, painful movement, and walking pattern
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• X-rays of the spine to evaluate vertebral height loss, wedge deformity, kyphosis, alignment, and possible additional fractures
• MRI of the spine to help determine whether a fracture is acute, subacute, or chronic and to evaluate nerve compression, spinal cord compression, tumor, infection, or soft-tissue findings
• CT scan to evaluate bone detail, fracture pattern, posterior wall involvement, spinal canal involvement, or surgical planning
• Bone density testing, also called DEXA scan, to evaluate osteoporosis or low bone density
• Blood tests in selected cases when metabolic bone disease, vitamin deficiency, infection, inflammation, multiple myeloma, or cancer-related concern is suspected
• Biopsy in selected cases when imaging or history raises concern for tumor, infection, or another pathologic cause
• Standing spine X-rays in selected cases to evaluate kyphosis, spinal alignment, or overall posture
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve structures is needed

The goal of diagnosis is to confirm the fracture, identify whether osteoporosis is contributing, evaluate spinal stability, determine whether nerves or the spinal cord are affected, and guide treatment planning.

Treatment Options

Treatment for osteoporotic spinal fractures depends on pain severity, fracture age, degree of vertebral collapse, spinal stability, neurological examination, bone density, imaging findings, activity limitations, and overall health. Not every osteoporotic spinal fracture requires surgery.

Treatment options may include:

• Activity modification to avoid lifting, bending, twisting, or movements that worsen pain during healing
• Pain medication when medically appropriate
• Anti-inflammatory medication or acetaminophen when appropriate based on medical history
• Bracing in selected cases to support the spine during healing
• Short-term rest with gradual return to movement when guided by a clinician
• Physical therapy after the appropriate healing period to improve posture, strength, balance, mobility, and safe movement mechanics
• Fall prevention strategies to reduce the risk of another fracture
• Osteoporosis evaluation and treatment to reduce future fracture risk
• Calcium, vitamin D, or bone-strengthening medication when recommended by the treating medical team
• Coordination with primary care, endocrinology, rheumatology, or osteoporosis specialists when bone health management is needed
• Kyphoplasty in selected painful osteoporotic compression fractures when symptoms, imaging, and clinical findings support vertebral augmentation
• Vertebroplasty in selected cases after careful review of risks, benefits, and alternatives
• Treatment of an underlying tumor, infection, or metabolic bone disease when one is identified
• Spinal decompression in selected cases when nerve or spinal cord compression is present
• Spinal fusion or stabilization in selected cases involving instability, progressive collapse, deformity, burst fracture features, neurologic compromise, or structural failure
• Rehabilitation and follow-up care to monitor pain, posture, walking, strength, bone health, and fracture healing

Surgery is not appropriate for every osteoporotic spinal fracture. Neurosurgical treatment may be considered when a fracture causes persistent severe pain, progressive collapse, spinal instability, neurological symptoms, spinal cord compression, deformity, or concern for a pathologic fracture.