Vertebral Compression Fractures

Vertebral compression fracture is a common complication of osteoporosis. It is often triggered by ordinary behaviors such as turning in bed, coughing, and sneezing, but traumatic or metastatic etiologies are also possible. Although patients with vertebral compression fractures are often asymptomatic, they can present with back pain that worsens with postural movement and the Valsalva maneuver, potentially impairing function. Long term, these fractures can cause kyphosis, decreased vertebral height, muscle atrophy, and further bone mineral density loss. Anteroposterior and lateral projection radiography of the spine should be the initial imaging modality, and magnetic resonance imaging can be used to confirm suspicious but radiography-negative cases. Conservative measures are the mainstay of treatment, with physical rehabilitation and pharmacotherapy for pain relief. In addition to nonsteroidal anti-inflammatory drugs and acetaminophen, several anti-osteoporotic medications can improve pain after fracture. Bracing and nerve root blocks have very limited evidence of short-term benefit. Surgical intervention with vertebroplasty or kyphoplasty can be considered when pain persists for 6 weeks despite conservative intervention. Prevention of low bone mineral density is critical for avoiding vertebral compression fractures.