Vertebral Compression Fracture

What is a vertebral compression fracture?

  • A vertebral compression fracture is also called VCF. It is a collapse or breakdown in one or more bones of your vertebrae. Vertebrae are round, strong bones that are stacked on top of each other. Your spine is made up of thirty-three vertebrae. The bones stack up in a line that goes down the middle of your back. Your spine protects your spinal cord. Nerves coming to and going from your spinal cord pass through your spine.

  • Compression fractures of the spine happen when there is too much pressure on the vertebra. The vertebra collapses, and becomes wedge shaped instead of round. The bone tissue on the inside of the vertebra may also get crushed and squeezed. Fractures may be mild or severe (very bad). They happen most often in the thoracic (middle) and lumbar (lower) parts of your spine.

What may cause a vertebral compression fracture?

  • Osteoporosis: This is a condition where your bones become weak and brittle. It is more common in those over 60 years of age, and in women after menopause (change of life). Ask your caregiver for more information about osteoporosis.

  • Injuries: Fractures can happen if you are in a car accident, or if you fall down. You may also get fractures when playing sports, or if you get in a fight. People who have weak bones can get fractures by bending forward, standing from a seated position, sneezing, or strong coughing.

  • Diseases: Diseases of the spine, such as cancer, infection, and avascular necrosis, can weaken your bones and cause fractures.

What may increase my risk for a vertebral compression fracture?

  • Age: The chance of having a vertebral fracture is higher as you get older.

  • Bone mineral density: Bone mineral density is the amount of calcium in your bones. Having low bone density increases your chances of having osteoporosis, and getting a VCF.

  • Diet and exercise: Not having enough calcium and vitamin D in your diet increases your risk of VCF. Drinking too much alcohol too often may weaken your bones, and lead to VCF. Your risk also is higher if you do no weight-bearing exercises, such as walking or jogging. Having a low body weight, or losing weight can also increase your risk.

  • Genetic: Having a close family member with a history of compression fractures.

  • Lifestyle choices: If you have a job where you need to lift and carry heavy loads, you are at higher risk of getting a VCF. Smoking also increases your risk.

  • Medical conditions: Long term diseases, such as liver cirrhosis, diabetes, and certain diseases of the thyroid gland or intestines (bowels).

  • Medicines: Taking medicines that can cause calcium to be lost from your bones. These include thyroid hormones, steroid medicine, antacids, and certain medicines used to treat cancer.

What are the signs and symptoms of an acute vertebral compression fracture?

An acute fracture occurs suddenly, such as from a fall. You may not have any signs and symptoms with a mild fracture, or you may have any of the following:

  • Back pain that gets worse when standing up or walking. The pain goes away when you lie still.

  • Muscle spasms in your back.

  • Pain when the fracture area is touched.

  • Problems passing urine, or having bowel movements.

  • Sudden, severe, and sharp back pain.

  • Sudden weakness in your arms or legs.

What are the signs and symptoms of a chronic vertebral compression fracture?

A chronic fracture has signs and symptoms that last longer than two months. You may have any of the following:

  • Depression (deep sadness) and trouble sleeping.

  • Your abdomen (stomach) looks larger than normal.

  • Kyphosis or lordosis. These are conditions that cause your spine to curve, making your back look rounded or curved.

  • Loss of feeling or weakness in your legs or arms.

  • Loss of height.

  • Mild back pain.

  • Trouble breathing and shortness of breath. You may have trouble bending, reaching, lifting, climbing steps, or walking.

How is a vertebral compression fracture diagnosed?

Your caregiver will ask you about injuries and diseases you have had in the past. Your caregiver will do a physical exam, and check your spine. Blood may be taken for tests. Tests may be done that use a special dye. The dye helps caregivers see your body areas clearly. Tell caregivers if you are allergic to iodine or shellfish (lobster, crab, or shrimp) as you may also be allergic to this dye. You may need any of the following tests:

  • Bone scan: This is a test to look at your spine. Caregivers can look at the pictures for broken bones, infections, or cancer in the spine.

  • Computed tomography scan: This is also called a CT scan. It is a type of x-ray that uses computers to take pictures of your spine.

  • Magnetic resonance imaging: This test is also called a MRI. During the MRI, pictures are taken of your spine using magnetic waves. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.

  • Positron emission tomography scan: This test is also called a PET scan. A PET scan shows how much blood and oxygen is flowing to an area of your spine. It may also show areas where there is cancer.

  • X-ray: This is a picture of your spine to show fractured vertebrae and other broken bones.

How is a vertebral compression fracture treated?

If you have a mild fracture, you may need to rest in bed for a short time. You may need to wear a back brace for 8 to 12 weeks. A brace may decrease your pain, and help your vertebrae heal. You may need to use a cane or walker. You may also need any of the following:

  • Medicine:

    • Bisphosphonates: This medicine can help you keep the bone strength that you have, and may help your bones get stronger.

    • Calcitonin: This medicine helps strengthen your bones. It can decrease the pain of a VCF when it is caused by osteoporosis. It can also decrease your risk of getting another fracture.

    • Hormones: Parathyroid hormone may be given to certain women to increase bone density, and decrease the risk of fractures. Certain women may be given the hormone estrogen to treat osteoporosis. Medicine called estrogen receptor modulators increase bone density and can help prevent fractures.

    • Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and swelling. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it when using this medicine.

    • Pain medicines: You may be given medicine to decrease the pain caused by a compression fracture. Acetaminophen is an over-the-counter medicine that caregivers may suggest to help manage pain. Taking too much acetaminophen can hurt your liver. Read labels so that you know the active ingredients in each medicine that you take. Talk to your caregiver before taking more than one medicine that contains acetaminophen. Ask your caregiver before taking over-the-counter medicine if you also take pain medicine ordered for you.

    • Supplements: You may need to take calcium and vitamin D to help strengthen your bones.

  • Therapy:

    • Occupational therapy: A caregiver will work with you using work, self-care, and other activities to help you in your daily life. Occupational therapy (OT) teaches special skills for bathing, dressing, cooking, eating, and driving. A caregiver may help you choose tools to use, and suggest ways to keep your home or workplace safe.

    • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

    • Other therapy: Caregivers may use radiotherapy, heat or ice packs, or massage to relieve muscle pain. Exercises to stretch your back muscles, biofeedback, deep breathing, and relaxation therapy may also help.

  • Surgery: You may need surgery if your pain, weakness, or numbness does not go away after using other treatments. Surgery may make your spine more stable, and help decrease pressure on your spinal nerves caused by the fracture. Ask your caregiver about the following:

    • Vertebroplasty: Bone cement is placed into the fractured vertebrae.

    • Kyphoplasty: A balloon is placed in the fractured vertebrae. Bone cement is put inside the space made by the balloon.

    • Open surgery: Open surgery returns bones to the right place by putting them together using wires, pins, plates, or screws.

What diet and exercise changes can help prevent a VCF?

  • Avoid drinking too much alcohol. Alcohol is found in beer, wine, liquor such as vodka and whiskey, or other adult drinks. Drinking alcohol can increase your risk of getting osteoporosis. Talk to your caregiver if you drink alcohol.

  • Eat foods rich in calcium and vitamin D. This includes milk, cheese, yogurt, salmon, tofu, almonds, and beans. Calcium and vitamin D help keep your bones strong, and decrease bone loss.

  • Exercise. Your caregiver may have you do weight-bearing exercises such as walking. You may also do non-weight-bearing exercises such as swimming, and bicycling. These exercises can help build strong bones and muscles.

  • Stay at the weight suggested by your caregiver. Weighing too much increases your risk of getting a back injury.

What else can I do to help prevent a vertebral compression fracture?

  • Do not smoke cigarettes, cigars, and pipes. For women, smoking increases your chance of early menopause, and lowering estrogen, which increases your risk of osteoporosis.

  • Have your bone mineral density checked. Ask your caregiver for more information about this test.

  • Keep your home safe. Have enough light so you can see clearly. Leave a light on at night to help you find your way to the bathroom and kitchen. Place carpet down in the bathroom instead of hard flooring. Hard flooring is slippery if it gets wet. Secure carpeting to the floor around all edges. Remove throw rugs, or secure them with double-sided tape, or special backing. Ask your caregiver for more information on how to prevent falls in your home.

  • Use a cane or walker when you are walking if caregivers tell you to. This will decrease your chance of falling. Ask caregivers for more information about using a cane or a walker.

  • Use medicines as ordered to prevent or treat osteoporosis.

  • Wear shoes with rubber bottoms. This will help prevent falls.

  • When picking things up, bend at the hips and knees. Never bend at your waist only. Use bent knees and your leg muscles, not your back as you lift the object. While lifting an object, hold it close to your chest. Try not to twist, or lift anything above your waist.

How can I sleep better when I have a VCF?

  • Avoid using a waterbed as it does not support your back well.

  • Sleep on a firm mattress. You may also put a one-half to one inch piece of plywood between the mattress and box spring.

  • Sleep on your back with a pillow under your knees. This will decrease pressure on your back. You may also sleep on your side with one or both of your knees bent, and a pillow between them. You may also try lying on your stomach with a pillow under you at waist level.

When should I call my caregiver?

Call your caregiver if:

  • You are not hungry, and you are losing weight.

  • You cannot sleep or rest because of back pain.

  • You have pain or swelling in your back that is getting worse, or does not go away.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You have questions or concerns about your fracture, medicine, or care.

  • You see that you are getting shorter over time.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You have new problems passing urine, or having bowel movements.

  • You have severe pain in your back after falling, bending forward, sneezing, or coughing strongly.

  • You suddenly cannot feel your legs.

  • You suddenly have trouble moving your arms or legs.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Where can I find more information?

Having a vertebral compression fracture may be hard for you and your family. A social worker can talk with you about what it is like to have a VCF. Contact the following for more information:

  • American Academy of Orthopaedic Surgeons
    6300 North River Road
    Rosemont , IL 60018-4262
    Phone: 1- 847 - 823-7186
    Web Address: http://www.aaos.org/
  • National Chronic Pain Outreach Association
    PO Box 274
    Millboro , VA 24460
    Phone: 1- 540 - 862-9437
    Web Address: www.chronicpain.org

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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