Osteoporotic spinal compression fractures

Last reviewed:October 2019

Last updated:August 2019

Summary

Osteoporotic spinal compression fractures are associated with significant performance impairments in physical, functional, and psychosocial domains.

Most are isolated fractures of the anterior spinal column related to low bone mineral density.

Postmenopausal women and patients taking long-term corticosteroid therapy are most susceptible.

The causative mechanism is a combination of flexion and axial compression loading.

It is important to exclude the possibility of pathological fracture due to malignancy or infection.

Treatment frequently involves pain relief, temporary use of an orthosis (e.g., Jewett/Lumbar brace or thoracolumbosacral orthosis) and walking aids (e.g., stick, elbow crutches, all-terrain rollator).

Radiographic and clinical follow-up is required every 6 weeks for 3 months post-injury.

Definition

Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading. The stability of the spine is not compromised with this type of fracture. These fractures are traditionally considered benign injuries that heal without complications.[1] Rarely, osteoporotic compression fractures can also involve the middle and/or posterior spinal columns, in addition to the anterior column. This type of fracture is potentially unstable and requires surgical intervention. com.bmj.content.model.Caption@778e9e9c [Figure caption and citation for the preceding image starts]: Lateral radiograph showing a T12 compression fracture in osteoporotic bonePersonal collection of Nasir A. Quraishi [Citation ends].[Figure caption and citation for the preceding image starts]: Burst fracture with large retropulsed fragment in spinal canal; the patient underwent posterior decompression and stabilisationPersonal collection of Nasir A. Quraishi [Citation ends]. com.bmj.content.model.Caption@7e8f0218 [Figure caption and citation for the preceding image starts]: Vertebral fracture-dislocation; the patient underwent posterior decompression and instrumented stabilisationPersonal collection of Nasir A. Quraishi [Citation ends].

History and exam

Key diagnostic factors

advanced age
previous osteoporotic vertebral compression fracture
acute back pain
asymptomatic

Full details

Other diagnostic factors

history of long-term corticosteroid use
kyphotic deformity
loss of lumbar lordosis
localised tenderness
loss of standing height
loss of sagittal balance

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Risk factors

older age (>50 years for women and >65 years for men)
previous osteoporotic vertebral compression fracture
low body weight
recent weight loss
family history of low bone mass/osteoporotic fractures
smoking
white or Asian race
postmenopausal status
secondary amenorrhoea
alcohol (>2 units/day)
corticosteroid use
glucocorticoid excess
hyperthyroidism
vitamin D deficiency
low calcium intake
rheumatoid arthritis and other autoimmune connective tissue diseases
endocrine disorders (e.g., hypogonadism, hyperparathyroidism, hyperprolactinaemia, acromegaly, hypercortisolism, hyperthyroidism)
gastrointestinal diseases (e.g., inflammatory bowel disease, coeliac disease, malabsorption syndromes, post-bariatric surgery)
liver diseases (e.g., biliary sclerosis, sclerosing cholangitis, alcoholic cirrhosis, autoimmune hepatitis)
dietary disorders (e.g., anorexia nervosa/bulimia, inadequate diet, total parenteral nutrition)
neurological disorders (e.g., stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, long-term immobilisation)
renal disease
type 1 diabetes mellitus
organ transplantation
bone-losing medications