Back Compression Fractures - Causes, Symptoms, Risk Factor, Diagnosis, Treatment and Prevention

Introduction:

Compression fractures of the back are known by several names, such as spinal compression fracture, vertebral compression fracture, compression fractures of the spine, or simply compression fractures.

Usually, bone density reduces with aging. This causes the small bones that make the backbone weak and develop tiny cracks even with simple everyday activities like bending, lifting the grandchildren, etc. These tiny cracks, over time, cause the vertebrae to collapse.

What Are Back Compression Fractures?

The backbone, or the spine, supports the central body and is not a single bone. It comprises numerous small bones called vertebrae and intervertebral disks to cushion the vertebrae. The spinal cord passes from the brain to the lower back through the spaces in the vertebrae called vertebral canals. Whenever any vertebral bone collapses or breaks, it is called a compression fracture.

These vertebral bones are stacked upon one another to form the spine. A break or fracture of one or more vertebral bones can cause the vertebrae to collapse, resulting in the shortening of the person’s stature. Back compression fractures can also impact the spinal cord. The collapsed vertebral bones can press against the spinal cord and nerves, compromising the blood supply to the spinal cord.

What Is the Incidence of Compression Fractures?

Fractures from compression are frequent. Every year, almost 1 million people in the United States suffer compression fractures. Osteoporosis, which produces weak, brittle bones, is more common in elderly women and increases the risk of spine fractures. They also affect elderly men. Compression fracture occurs more frequently in women who have gone through menopause. Approximately 50 % of adults aged 80 or older have experienced a compression fracture.

What Causes Back Compression Fractures?

• Osteoporosis—The predominant cause of compression fractures is osteoporosis. In osteoporosis, the bones become fragile and break easily. As people age, they tend to lose calcium and other minerals, resulting in osteoporosis. The backbone loses its ability to withstand normal forces from everyday activities.

• Severe Osteoporosis - People with severe osteoporosis can be susceptible to compression fractures even with simple day-to-day activities like lifting lightweight objects or forceful sneezing or coughing.

• Moderate Osteoporosis—Activities such as lifting heavy weights, falling from bed, or standing can cause compression fractures in people with moderate osteoporosis.

• Trauma - People with healthy bones can develop compression fractures due to trauma to their back from a car accident, sports injury, falling hard, etc.

• Tumors - A tumor of the spine, such as multiple myeloma can weaken the vertebral bones and cause compression fractures.

• Metastatic Cancer - A tumor from somewhere else in the body can metastasize and spread to the backbone. This, too, can cause compression fractures.

If back compression fractures are reported in people aged less than 55 years without any history of trauma, metastatic tumors are mostly suspected to be the cause. The backbone is the region where metastatic cancer most commonly spreads.

Can Compression Fractures Be Prevented?

It might not be possible to stop compression fractures all the time. To lower the likelihood of experiencing an osteoporosis-related compression fracture, one should do the following:

• Steer clear of binge drinking.

• Consume a balanced diet and get enough calcium and vitamin D to build strong bones.

• Give up tobacco usage, including smoking, as nicotine affects bones and increases the risk of cancer.

• If individuals are at risk for osteoporosis, they should see a physician for routine examinations and take the prescribed medicine to slow bone loss.

What Is the Prognosis for Persons Suffering From Compression Fractures?

Age, the kind and extent of the fracture, and general health all affect the prognosis. A few months of bed rest, restricted mobility, and medication are often enough to repair compression fractures.

What Symptoms Do Back Compression Fractures Cause?

People with compression fractures can experience one or more of the following symptoms:

• Abrupt severe back pain.

• The pain can be perceived on all parts of the spine and the sides of the back, but it is more pronounced in the middle and lower spine.

• The pain can be sharp.

• Pain worsens when standing or walking.

• Pain decreases in intensity and improves while lying on the back.

• Limited range of motion and flexibility of the spine.

• Kyphosis (stooped and humped posture of the upper body).

• Shortening stature.

• Eventual disability.

• When the fracture puts pressure on the spinal cord, problems with walking and controlling bowel and bladder function can occur, as well as muscle weakening and a tingling sensation in regions supplied by the affected nerve.

Who Is at Risk for Spinal Compression Fracture?

• Older adults (aged 55 and above).

• Women around menopausal age.

• People with osteoporosis.

• People with a history of compression fractures.

• People with cancer.

• Asians and white women have a high risk.

• Smokers.

• Slim women.

How Can Vertebral Compression Fractures Be Diagnosed?

The physician can establish a diagnosis with a physical examination and a medical history.

But the following tests can help confirm the diagnosis:

• X-Rays - This can reveal any bony spurs that are irritating the spinal nerves and causing disc degeneration.

• CT (Computed Tomography) - This visualizes the vertebral canal and shows any space narrowing.

• MRI (Magnetic Resonance Imaging)—MRI can reveal tumors, degeneration, enlargement, the spinal cord, and nerve roots in the backbone.

• DEXA (Dual-Energy X-ray Absorptiometry) Scan—Also known as bone densitometry, DEXA scans can measure bone mineral density and diagnose osteoporosis.

How Are Compression Fractures Treated?

Conservative Management:

• After a vertebral fracture, a physician will advise one to limit certain activities that strain the back.

• The medications commonly advised for compression fractures are:

  • Acetaminophen.

  • Nonsteroidal anti-inflammatory drugs.

  • Muscle relaxants.

  • Opioids.

• Patients will need to wear a back brace to prevent the movement of a fractured vertebra.

• If osteoporosis is diagnosed, the following drugs to strengthen the bones and slow down the progression of the condition will be prescribed;

  • Bisphosphonates.

  • Denosumab.

  • Raloxifene.

  • Teriparatide.

  • Zoledronic acid.

Surgical Management:

• Vertebroplasty—This procedure is done either under general or local anesthesia and takes up to two hours. With X-ray guidance, acrylic bone cement is injected with a needle into the affected vertebra. As it hardens, this cement stabilizes the fractured vertebra. As the fractured components stabilize, the patient experiences an improvement in pain.

• Kyphoplasty - This procedure is similar to vertebroplasty except that a balloon is introduced into the vertebrae through a hollow needle to create space between the collapsed vertebrae, and then cement is placed.

Both are minimally invasive procedures, only preferred after conservative management methods have failed to show results. Individuals can go home the same day or stay in observation for that night and leave. They can carry on their daily activities and strictly limit strenuous physical activities.

How Can Compression Fractures Be Prevented?

The following factors help prevent the risk of bone thinning and fractures:

• Take calcium supplements.

• Prevent frequent falls.

• Get more vitamin D from sun exposure and supplements if needed.

• Quit smoking.

• Regularly practice strength-building exercises.

• If one has osteoporosis, one should consult a doctor and take bone-strengthening medicines.

Conclusion:

Back compression fractures most commonly affect elderly people. Hence, women above the menopausal age (above 50) and men aged 55 and older must be cautious of their bone health. Calcium supplementation can be started early with a doctor’s advice. If one has constant back pain, do not conclude it is due to arthritis or joint pain; seek a medical opinion to rule out compression fractures.