Osteoporotic fractures (fragility fractures, low-trauma fractures) are those occurring from a fall from a standing height or less, without major trauma such as a motor vehicle accident.
Vertebral compression fractures are the most common type of osteoporotic fracture . They often occur at the thoracolumbar junction (T12-L1) because a change in the facets provides less resistance to anteroposterior displacement at this level . Midthoracic (T7-T8) fractures are also common. Fractures may result in limitation of ambulation, depression, loss of independence, and chronic pain. In addition, the presence of a fragility (low-trauma) fracture is an important risk factor for subsequent fracture.
This topic will review the clinical manifestations, diagnosis, and management of acute osteoporotic vertebral compression fractures. The diagnosis and treatment of osteoporosis are reviewed separately. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women" and "Clinical manifestations, diagnosis, and evaluation of osteoporosis in men" and "Overview of the management of osteoporosis in postmenopausal women" and "Treatment of osteoporosis in men".)
Symptoms — Most vertebral compression fractures (about two-thirds) are asymptomatic; they are diagnosed as an incidental finding on chest or abdominal x-ray. In some patients, the presence of vertebral fractures may become apparent because of height loss or kyphosis . (See 'Height loss' below and 'Kyphosis' below.)
In patients who have a symptomatic vertebral fracture, there is often no history of preceding trauma. The typical patient presents with acute back pain after sudden bending, coughing, or lifting. Occasionally, minor trauma, such as going over speed bumps, may precipitate a fracture . The pain often radiates bilaterally into the anterior abdomen in the distribution of contiguous nerve routes, a so-called "girdle of pain." By contrast, radiation into the legs, as may be seen with a herniated disc, is rare with compression fractures.