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Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment

Harold N Rosen, MD
David Richard Walega, MD
Section Editor
Clifford J Rosen, MD
Deputy Editor
Jean E Mulder, MD


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 [1]. They often occur at the midthoracic (T7-T8) spine and the thoracolumbar junction (T12-L1). Fractures may result in significant back pain, limited physical functioning and activities of daily living, and can lead to loss of independence, depression, and chronic pain. Osteoporotic 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 and signs — Osteoporotic vertebral compression that occurs slowly over time is often asymptomatic. Old or healed fractures may be an incidental finding on radiographs of the chest or abdomen. In other patients, the presence of vertebral fractures may become apparent because of height loss or kyphosis [2]. In contrast, acute episodes of significant vertebral body compression are associated with pain. The pain may be tolerable and resolve without medical intervention (but the patient can often recall the episode of pain when a fracture is incidentally found on other imaging) or the pain may be incapacitating, requiring hospital admission and parenteral opioids. (See 'Height loss' below and 'Kyphosis' below.)

In patients who have acute symptomatic vertebral body 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 [3]. The pain is usually well localized to the midline spine but often refers in a unilateral or bilateral pattern into the flank, anterior abdomen, or the posterior superior iliac spine. By contrast, radiation of pain into the legs, as may be seen with a herniated disc, is rare with compression fractures but may herald spinal cord or nerve root compression from retropulsed bone fragments.

The pain from a vertebral compression fracture is variable in quality and may be sharp or dull. Sitting, spine extension, Valsalva maneuver, and movement often aggravate the pain and may be accompanied by muscle spasms. Sleep may be disturbed by pain. On physical examination, the patient may experience pain upon palpation and percussion of the corresponding spinous process and paravertebral structures.

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Literature review current through: Nov 2017. | This topic last updated: Aug 30, 2017.
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