Many people think about broken hips when they hear the word “osteoporosis,” but did you know that most fractures caused by osteoporosis occur in the spine? That’s right, about 700,000 people per year experience fractures of the spine due to osteoporosis. These fractures are known as osteoporotic compression fractures.
Osteoporotic compression fractures can be painful, but luckily there are a variety of treatment options available. Here’s how they happen, how they’re detected and how they’re cared for.
What Is Osteoporosis?
Osteoporosis is a relatively common condition that usually affects people as they age. Osteoporosis is a decline in bone strength and mass, causing the bones to become weak and thin. That weakness puts people at increased risk of fracture. The word “osteoporosis” means “porous bones,” and that’s exactly what we see on X-rays: The bones of people with osteoporosis are covered in small holes, making them look—and, to some extent, feel—like a sponge.
Osteoporosis occurs when bone loss outpaces bone growth. This usually happens after about the age of 30. Postmenopausal women have the greatest risk of osteoporosis due to the decline in estrogen production after menopause, because estrogen slows bone loss and promotes bone growth.
You can ward off osteoporosis by:
- Engaging in weight-bearing exercises like running or resistance training
- Getting enough calcium
- Getting enough vitamin D
What Are Osteoporotic Compression Fractures?
Osteoporotic compression fractures happen when vertebrae—backbones—weaken from osteoporosis and develop cracks. This causes them to lose their height, or compress.
The vertebrae are hollow in the middle to allow the spinal cord to run through them. Nerves and nerve roots branch from the spinal cord and run out to other parts of the body. Each vertebra also has a fibrocartilage disc that acts as a shock absorber.
When vertebrae compress due to osteoporotic fractures, the abnormal shape can lead to pressure on the nerve roots or can cause the intervertebral discs to bulge or herniate. Depending on which vertebrae and nerves are affected, this can lead to back pain, as well as pain, tingling, numbness and weakness to other parts of the body (called radiculopathy or referred pain).
Diagnosing Osteoporotic Compression Fractures
If I suspect one of my patients has a compression fracture, I start with a physical exam and a medical history. The medical history can tell me a lot about a person’s bone health, and from there I can determine if they likely have osteoporosis. I pay special attention when a postmenopausal woman tells me she has back pain or radiculopathy because I know how common osteoporosis is in that demographic.
During a physical exam, I check how the patient is standing and walking. An abnormal stance or gait could suggest that there is a spine problem. I may also press on various spots on the back to try to determine where any pain is starting. I will also perform a neurological evaluation to check for any nerve damage or issues.
There are a number of tests available to check for the presence of both osteoporosis and vertebral fractures. Bone density testing—checking to see how much mass your bones have—is the way to uncover osteoporosis, and there are a variety of ways to check this.
The most common osteoporosis test is the DEXA scan. This test, short for dual-energy X-ray absorptiometry (also abbreviated DXA), uses a special kind of X-ray to measure bone density. I sometimes order a special kind of computed tomography (CT) scan, called a quantitative CT scan, for the same purpose.
X-rays are the most common way to detect a fracture. Magnetic resonance imaging (MRI) scans can add more detail about the fracture.
Osteoporotic Compression Fracture Treatment
Very often, osteoporotic compression fractures can be treated without surgery. The majority of osteoporotic compression fractures heal after about three months. Most of the time, rest and some medication to control pain will do the trick. Sometimes I’ll recommend that my patients use a back brace to keep spinal movement to a minimum, which will cut down on the pain and promote healing.
If conservative measures are ineffective, the fracture might require surgery. Kyphoplasty is one of the most effective surgical treatments for compression fractures. During kyphoplasty, I insert a needle into the fractured vertebrae, and then I inject a device called a balloon tamp. The balloon tamp is inflated to create space, then deflated and that space is filled with bone cement to prop up the backbone and return it to its proper height and structure.
If you are experiencing back pain, request an appointment with me so we can determine its source. Whether your pain comes from an osteoporotic compression fracture or something else, together we’ll develop a treatment plan that’s right for you.