Spine fractures and bone health

Vertebral compression fractures

A vertebral compression fracture is a fracture in a spine bone that can happen with osteoporosis or other causes of bone fragility. Some are dramatic and painful. Others are discovered later on imaging.

What it is

The vertebral body is the front weight-bearing part of a spine bone. In a compression fracture, that body loses height, often forming a wedge shape. Osteoporosis is a common contributor, but the clinical story and imaging matter.1

Symptoms can vary

Possible symptomsSudden back pain, pain with standing or walking, height loss, kyphosis, muscle spasm, or trouble with ordinary activity.
Sometimes subtleSome vertebral fractures are found on x-ray, CT, MRI, or vertebral fracture assessment when the person did not realize a fracture had occurred.
Urgent symptoms: New leg weakness, numbness, bowel or bladder changes, fever, cancer history, major trauma, or severe unrelenting pain should be addressed urgently.

How this connects to bone health

A vertebral compression fracture is a strong fracture-risk signal, even when it is found incidentally or when a DXA scan does not show a T-score of -2.5 or lower. It can change treatment thresholds and should trigger questions about spine imaging, pain control, mobility, bracing, physical therapy, medications, fall prevention, and evaluation for secondary causes.2,3,4

Questions to ask

  • Is this fracture acute, old, or uncertain?
  • Do we need MRI, x-ray follow-up, or vertebral fracture assessment?
  • Should I avoid certain bending, twisting, or lifting while healing?
  • Does this fracture change my osteoporosis treatment threshold?
  • Do I need lab testing for secondary causes or referral to a bone-health clinician?

Evidence review

Biology

Vertebral compression fractures occur when spinal bone strength is not enough for the load placed on it. They may follow a fall, lifting/twisting event, or sometimes no memorable injury. Their importance is not only pain; they can signal high future fracture risk.13

Presentation

Some vertebral fractures cause acute back pain, while others are found later through height loss, kyphosis, or imaging done for another reason. They are commonly under-recognized, including in patients who already have another fragility fracture.51

Evaluation

Evaluation should clarify acuity, neurologic symptoms, cancer or infection red flags, prior fractures, DXA results, and secondary causes. Imaging details matter because treatment differs for acute painful fractures, chronic deformity, and fractures with concerning features.13

Treatment strategy

Care usually combines pain control, safe mobilization, posture and strength work, fall prevention, nutrition, and osteoporosis treatment when indicated. Procedures may have a role in selected cases, but they do not replace evaluation and secondary fracture prevention.67

References

  1. Robinson WA, Carlson BC, Poppendeck H, et al. Osteoporosis-related vertebral fragility fractures: a review and analysis of the American Orthopaedic Association’s Own the Bone database. Spine. 2020;45(8):E430-E438. doi:10.1097/BRS.0000000000003324.
  2. Matzkin EG, DeMaio M, Charles JF, Franklin CC. Diagnosis and treatment of osteoporosis: what orthopaedic surgeons need to know. J Am Acad Orthop Surg. 2019;27(20):e902-e912. doi:10.5435/JAAOS-D-18-00600.
  3. Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025. doi:10.1001/jama.2025.6003.
  4. Robinson WA, Carlson BC, Poppendeck H, et al. Osteoporosis-related vertebral fragility fractures: a review and analysis of the American Orthopaedic Association’s Own the Bone database. Spine. 2020;45(8):E430-E438. doi:10.1097/BRS.0000000000003324.
  5. Muzzammil M, Bhura S, Shabbir Hussain A, et al. Undiagnosed vertebral fragility fractures in patients with distal radius fragility fractures: an opportunity for prevention of morbimortality in osteoporotic patients in developing countries. Osteoporos Int. 2024. doi:10.1007/s00198-024-07149-7. PMID:38900165.
  6. Chandran M, Akesson KE, Javaid MK, et al. Impact of osteoporosis and osteoporosis medications on fracture healing: a narrative review. Osteoporos Int. 2024. doi:10.1007/s00198-024-07059-8. PMID:38587674.
  7. Rogmark C, Frihagen F. What’s New in Osteoporosis and Fragility Fractures. J Bone Joint Surg Am. 2025. doi:10.2106/JBJS.25.00574. PMID:40712043.

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