User:Ro016281/Vertebral compression fracture: Difference between revisions

 

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== Signs and symptoms ==

== Signs and symptoms ==

Acute fractures ”’usually present with”’ <s>will cause severe</s> [[back pain]], with other possible signs including ”’reduced range of motion and even nerve deficits”’.<ref name=”:0″>{{Cite journal |last=Alsoof |first=Daniel |last2=Anderson |first2=George |last3=McDonald |first3=Christopher L. |last4=Basques |first4=Bryce |last5=Kuris |first5=Eren |last6=Daniels |first6=Alan H. |date=July 2022 |title=Diagnosis and Management of Vertebral Compression Fracture |url=https://linkinghub.elsevier.com/retrieve/pii/S0002934322001929 |journal=The American Journal of Medicine |language=en |volume=135 |issue=7 |pages=815–821 |doi=10.1016/j.amjmed.2022.02.035}}</ref> ”’Additionally, presence of a [[bruise]] or [[Abrasion (medicine)|scrape]] combined with localized back pain may indicate the need to further investigate for evidence of a compression fracture.”'<ref>{{Cite journal |last=Han |first=Christopher S |last2=Hancock |first2=Mark J |last3=Downie |first3=Aron |last4=Jarvik |first4=Jeffrey G |last5=Koes |first5=Bart W |last6=Machado |first6=Gustavo C |last7=Verhagen |first7=Arianne P |last8=Williams |first8=Christopher M |last9=Chen |first9=Qiuzhe |last10=Maher |first10=Christopher G |date=2023-08-24 |editor-last=Cochrane Back and Neck Group |title=Red flags to screen for vertebral fracture in people presenting with low back pain |url=http://doi.wiley.com/10.1002/14651858.CD014461.pub2 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=8 |doi=10.1002/14651858.CD014461.pub2}}</ref> ”’Chronic”’ compression fractures <s>which develop gradually</s>, such as in osteoporosis, may initially not cause any symptoms, but will later often lead to back pain, ”’spinal deformities,”’ <s>and</s> loss of height, ”’and presence of neurologic issues”’.<ref name=”:0″ />

Acute fractures ”’usually present with”’ <s>will cause severe</s> [[back pain]], with other possible signs including ”’reduced range of motion and even nerve deficits”’.<ref name=”:0″>{{Cite journal |last=Alsoof |first=Daniel |last2=Anderson |first2=George |last3=McDonald |first3=Christopher L. |last4=Basques |first4=Bryce |last5=Kuris |first5=Eren |last6=Daniels |first6=Alan H. |date=July 2022 |title=Diagnosis and Management of Vertebral Compression Fracture |url=https://linkinghub.elsevier.com/retrieve/pii/S0002934322001929 |journal=The American Journal of Medicine |language=en |volume=135 |issue=7 |pages=815–821 |doi=10.1016/j.amjmed.2022.02.035}}</ref> ”’Additionally, presence of a [[bruise]] or [[Abrasion (medicine)|scrape]] combined with localized back pain may indicate the need to further investigate for evidence of a compression fracture.”'<ref>{{Cite journal |last=Han |first=Christopher S |last2=Hancock |first2=Mark J |last3=Downie |first3=Aron |last4=Jarvik |first4=Jeffrey G |last5=Koes |first5=Bart W |last6=Machado |first6=Gustavo C |last7=Verhagen |first7=Arianne P |last8=Williams |first8=Christopher M |last9=Chen |first9=Qiuzhe |last10=Maher |first10=Christopher G |date=2023-08-24 |editor-last=Cochrane Back and Neck Group |title=Red flags to screen for vertebral fracture in people presenting with low back pain |url=http://doi.wiley.com/10.1002/14651858.CD014461.pub2 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=8 |doi=10.1002/14651858.CD014461.pub2}}</ref> ”’Chronic”’ compression fractures <s>which develop gradually</s>, such as in osteoporosis, may initially not cause any symptoms, but will later often lead to back pain, ”’spinal deformities,”’ <s>and</s> loss of height, ”’and neurologic issues”’.<ref name=”:0″ />

== Causes ==

== Causes ==

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== Mechanism ==

== Mechanism ==

”’The pathophysiology of vertebral compression fractures stems from decreasing [[Trabecula#Bone trabecula|trabecular bone]] in vertebral bodies (most commonly due to osteoporosis), usually from an imbalance in the body’s regulation in bone resorption and bone formation, leading to weakened vertebrae prone to fracture.”'<ref name=”:1″>{{Cite journal |last=Schoenlank |first=Casey |last2=Thomas |first2=Alphonsa |last3=Bakshiyev |first3=Raisa |last4=Chen |first4=SuAnn |date=May 2025 |title=Osteoporosis Issues Regarding Rehabilitation in Women |url=https://linkinghub.elsevier.com/retrieve/pii/S1047965124001050 |journal=Physical Medicine and Rehabilitation Clinics of North America |language=en |volume=36 |issue=2 |pages=361–370 |doi=10.1016/j.pmr.2024.11.004}}</ref> ”’Factors that can contribute to trabecular bone loss include lack of physical activity, nutrition, aging, medications, genetics, and systemic disease.”'<ref name=”:2″>{{Cite journal |last=Imamudeen |first=Nasvin |last2=Basheer |first2=Amjad |last3=Iqbal |first3=Anoop Mohamed |last4=Manjila |first4=Nihal |last5=Haroon |first5=Nisha Nigil |last6=Manjila |first6=Sunil |date=June 2022 |title=Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms |url=http://www.clinmedres.org/lookup/doi/10.3121/cmr.2021.1612 |journal=Clinical Medicine & Research |language=en |volume=20 |issue=2 |pages=95–106 |doi=10.3121/cmr.2021.1612 |issn=1539-4182}}</ref> ”’Women in postmenopause are especially prone to increased trabecular bone loss as a result of hormonal changes.”'<ref name=”:1″ />

”’The pathophysiology of vertebral compression fractures stems from decreasing [[Trabecula#Bone trabecula|trabecular bone]] in vertebral bodies (most commonly due to osteoporosis), usually from an imbalance in bone resorption and formation, leading to weakened vertebrae prone to fracture.”'<ref name=”:1″>{{Cite journal |last=Schoenlank |first=Casey |last2=Thomas |first2=Alphonsa |last3=Bakshiyev |first3=Raisa |last4=Chen |first4=SuAnn |date=May 2025 |title=Osteoporosis Issues Regarding Rehabilitation in Women |url=https://linkinghub.elsevier.com/retrieve/pii/S1047965124001050 |journal=Physical Medicine and Rehabilitation Clinics of North America |language=en |volume=36 |issue=2 |pages=361–370 |doi=10.1016/j.pmr.2024.11.004}}</ref> ”’Factors that can contribute to trabecular bone loss include lack of physical activity, nutrition, aging, medications, genetics, and systemic disease.”'<ref name=”:2″>{{Cite journal |last=Imamudeen |first=Nasvin |last2=Basheer |first2=Amjad |last3=Iqbal |first3=Anoop Mohamed |last4=Manjila |first4=Nihal |last5=Haroon |first5=Nisha Nigil |last6=Manjila |first6=Sunil |date=June 2022 |title=Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms |url=http://www.clinmedres.org/lookup/doi/10.3121/cmr.2021.1612 |journal=Clinical Medicine & Research |language=en |volume=20 |issue=2 |pages=95–106 |doi=10.3121/cmr.2021.1612 |issn=1539-4182}}</ref> ”’Women in postmenopause are especially prone to increased trabecular bone loss as a result of hormonal changes.”'<ref name=”:1″ />

== Diagnosis ==

== Diagnosis ==

Compression fractures are usually diagnosed on [[Spinal radiograph|spinal radiographs]], ”’often incidentally,”’ where a <s>wedge-shaped vertebra</s> ”’vertebral deformity”’ may be visible or there may be loss of height of the vertebra.<ref name=”:0″ /> ”’Compression fractures are frequently classified using the Genant classification based on the pattern of vertebral height loss: wedge, biconcave, and crush.”'<ref name=”:0″ /> In addition, [[bone density measurement]] may be performed to evaluate for osteoporosis.<ref name=”:0″ /> When a tumor is suspected as the underlying cause, ”’or there is evidence of nerve deficits,”’ <s>or the fracture was caused by severe trauma,</s> [[X-ray computed tomography|CT]] or [[MRI]] scans may be performed.<ref name=”:0″ /> ”’Clinical guidelines can help determine the most appropriate imaging for individuals with newly diagnosed symptomatic fractures, back pain with history of prior compression fractures, and history of malignancy.”'<ref name=”:3″>{{Cite web |title=Management of Vertebral Compression Fractures |url=https://acsearch.acr.org/docs/70545/Narrative/ |access-date=2026-01-15 |website=American College of Radiology}}</ref><gallery widths=”200″ heights=”350″>

Compression fractures are usually diagnosed on [[Spinal radiograph|spinal radiographs]], ”’often incidentally,”’ where a <s>wedge-shaped vertebra</s> ”’vertebral deformity”’ may be visible or there may be loss of height of the vertebra.<ref name=”:0″ /> ”’Compression fractures are frequently classified using the Genant classification based on the pattern of vertebral height loss: wedge, biconcave, and crush.”'<ref name=”:0″ /> In addition, [[bone density measurement]] may be performed to evaluate for osteoporosis.<ref name=”:0″ /> When a tumor is suspected as the underlying cause, ”’or there is evidence of nerve deficits,”’ <s>or the fracture was caused by severe trauma,</s> [[X-ray computed tomography|CT]] or [[MRI]] scans may be performed.<ref name=”:0″ /> ”’Clinical guidelines can help determine appropriate imaging for individuals with newly diagnosed symptomatic fractures, back pain with history of prior compression fractures, and history of malignancy.”'<ref name=”:3″>{{Cite web |title=Management of Vertebral Compression Fractures |url=https://acsearch.acr.org/docs/70545/Narrative/ |access-date=2026-01-15 |website=American College of Radiology}}</ref><gallery widths=”200″ heights=”350″>

File:L4 Compression Fracture Arrow.png|Compression fracture of the fourth lumbar vertebra post falling from a height.

File:L4 Compression Fracture Arrow.png|Compression fracture of the fourth lumbar vertebra post falling from a height.

File:L3 CompressionFracture Arrow.png|X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.

File:L3 CompressionFracture Arrow.png|X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.

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Acute fractures usually present with will cause severe back pain, with other possible signs including reduced range of motion and even nerve deficits.^[1] Additionally, presence of a bruise or scrape combined with localized back pain may indicate the need to further investigate for evidence of a compression fracture.^[2] Chronic compression fractures which develop gradually, such as in osteoporosis, may initially not cause any symptoms be asymptomatic, but will later often lead to back pain, spinal deformities, and loss of height, and neurologic issues.^[1]

Traumatic compression fractures tend to occur after a significant fall or impact, but in those with low bone density even daily activities can result in a fracture.^[1] Atraumatic fractures are usually attributable to an underlying issue such as osteoporotic bone, tumors, and infections.^[1]

Risk factors include osteoporosis, history of previous compression fractures, elderly age, and postmenopausal status.^[1]

The pathophysiology of vertebral compression fractures stems from decreasing trabecular bone in vertebral bodies (most commonly due to osteoporosis), usually from an imbalance in bone resorption and formation, leading to weakened vertebrae prone to fracture.^[3] Factors that can contribute to trabecular bone loss include lack of physical activity, nutrition, aging, medications, genetics, and systemic disease.^[4] Women in postmenopause are especially prone to increased trabecular bone loss as a result of hormonal changes.^[3]

Compression fractures are usually diagnosed on spinal radiographs, often incidentally, where a wedge-shaped vertebra vertebral deformity may be visible or there may be loss of height of the vertebra.^[1] Compression fractures are frequently classified using the Genant classification based on the pattern of vertebral height loss: wedge, biconcave, and crush.^[1] In addition, bone density measurement may be performed to evaluate for osteoporosis.^[1] When a tumor is suspected as the underlying cause, or there is evidence of nerve deficits, or the fracture was caused by severe trauma, CT or MRI scans may be performed.^[1] Clinical guidelines can help determine appropriate imaging for individuals with newly diagnosed symptomatic fractures, back pain with history of prior compression fractures, and history of malignancy.^[5]

• 

  Compression fracture of the fourth lumbar vertebra post falling from a height.

• 

  X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.

• 

  Compression fracture of T12.

• Back brace for support while the bone heals; —either a Jewett brace for relatively stable and mild injuries, or a thoracic lumbar sacral orthosis (TLSO) for more severe ones rigid braces have demonstrated pain relief for up to 6 months in acute vertebral compression fractures.^[6]
• Opioids or non-steroidal anti-inflammatory drugs (NSAIDs) for pain management, especially in the short-term setting.^[1] For osteoporotic patients, calcitonin may be helpful.^[7][8]

• Kyphoplasty Vertebroplasty^[9] and vertebroplasty kyphoplasty^[9][10] are minimally invasive procedures that inject cement into the vertebra bone of the back that is fractured. These surgeries are similar, except that kyphoplasty inserts a balloon before the cement is introduced, which can result in some vertebral height restoration.^[9] However, the data examining the The effectiveness of these procedures is mixed is debated, but recent studies demonstrate improved pain relief and an association with decreased mortality.^{[4] [11][12]}

Treatment goals focus on pain control, increased mobility, and restoration of functionality.^[1] Presentation and patient history can further dictate whether to pursue conservative or surgical options.^[5]

The mainstay in preventing compression fractures involves targeting the root cause, most commonly osteoporosis.^[1] Maintaining proper calcium and vitamin D levels as well as use of medications, such as bisphosphonates, can slow down bone loss.^[1] Physical activity to improve posture and mobility can also mitigate fall risk to prevent fractures.^[1]

In some cases, vertebral compression fractures can lead to further complications, including deep venous thrombosis from lack of movement, bowel problems, and breathing difficulties.^[1] Rarely, Kümmel’s disease, which is avascular necrosis of the vertebral body, can occur following compression fractures.^[13]

Vertebral compression fractures affect about 700,000 individuals in the United States annually, with a higher prevalence in older populations.^[1] Women are also affected more frequently than men, with about a quarter of postmenopausal women experiencing compression fractures.^[1] The thoracolumbar region tends to be where these fractures are most often located.^[3]