A spinal compression fracture is a break where one of the bones of your spine, a vertebra, collapses a little, usually at the front.
In older adults it’s most often caused by osteoporosis, bone that has thinned and weakened. It can happen after something as small as lifting a bag, bending over, a hard cough or a minor fall.
The good news: most people feel better within about 3 months without surgery. The pain is usually worst in the first few weeks, then eases steadily.
More importantly: this fracture is a WARNING.
Bone that broke this easily can break again, and the risk is highest in the first year. Treating your bones matters as much as treating the pain.
Symptoms
- Sudden back pain, often in the middle or lower back, sometimes after a strain so minor you barely remember it. Some come on with no clear trigger at all
- Pain that’s worse when you move, especially getting in and out of bed, standing up or twisting. Lying still usually eases it
- Pain when you cough or sneeze
- Pain that wraps around to the front, along the ribs or across the belly, in some people
- Losing height or becoming more stooped, especially after more than one fracture
- No pain at all. More than 2 in 3 of these fractures cause no obvious symptoms and are only spotted on an X-ray taken for something else
A compression fracture isn’t the same as a slipped disc. Disc problems often send pain shooting down the leg, while osteoporotic compression fractures rarely press on nerves. See slipped disc.
How it’s diagnosed
An X-ray usually shows the fracture. An MRI or CT scan may be used to tell a new fracture from an old one, or if there’s any doubt about the cause. A bone density scan, often called a DEXA scan, checks for osteoporosis.
How it’s treated
- Pain relief: regular pain relief in the early weeks lets you keep moving. Your doctor will choose what’s safe for you. Some stronger painkillers cause drowsiness or constipation, which matters if you’re already unsteady on your feet
- Stay as active as the pain allows: short walks, little and often. Long spells in bed weaken muscles and bones further. Rest when you need to, then move again
- Move with care: roll onto your side to get out of bed, hold things close to your body, and avoid heavy lifting and bending forward from the waist in the early weeks
- Bracing: some doctors suggest a back brace for comfort in the first weeks. The research on braces is mixed, so treat it as a comfort option, not a must
- Physio: once the worst pain settles, a physio can build the muscles along your spine, your posture and your balance. Stronger back muscles support the spine, and better balance means fewer falls
Kyphoplasty and vertebroplasty
Both procedures inject bone cement into the broken vertebra through a needle. In kyphoplasty, a small balloon is inflated first to make a space for the cement.
- The evidence is mixed. In trials where some people had vertebroplasty and others had a fake procedure that looked the same, the real procedure did no better on average
- Kyphoplasty has mostly been compared with usual care, not with a fake procedure, so it’s harder to know how much of the benefit comes from the cement itself. Some trials suggest people feel better sooner
- It’s usually considered only when a recent fracture, confirmed on MRI, still causes severe pain or stops you moving after several weeks of other treatment
- It has risks, including cement leaking out of the bone. Ask your specialist what they expect it to change for you
The pain tells you a bone has broken. The fracture tells you your bones need treating.
Preventing the next fracture
In a large group of older women, about 1 in 5 who broke a vertebra had another spine fracture within a year. That’s why this fracture should always lead to a conversation about bone health.
- Ask for a bone density scan if you haven’t had one, and ask whether you need bone-strengthening medicine. These medicines lower the risk of further fractures
- Calcium and vitamin D: aim to get enough through food, and ask your doctor whether you need a supplement
- Exercise for bone and balance: walking, strength training and balance work help your bones and cut your risk of falling. A physio can show you safe ways to strengthen your back
- Go easy on repeated or loaded forward bending, such as sit-ups or toe touches. Bend at your hips and knees instead
- Make your home safer: good lighting, no loose rugs, and grab rails where you need them
- Stop smoking and keep alcohol moderate: both weaken bone
The same thinking applies after any break from a minor fall, such as a broken hip. See hip fracture surgery recovery.
Go to the emergency department now if
These can be signs that nerves at the bottom of the spine are being squashed, called cauda equina syndrome, or of a more serious spinal injury. It’s rare, but it needs hospital assessment the same day.
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Numbness around your genitals, buttocks or inner thighs, the area that would touch a saddle
- Weakness or numbness in BOTH legs, or new weakness in one leg
- Back pain after a serious injury, such as a car accident or a fall from a height
Get it checked soon if
- The pain isn’t improving at all after a few weeks, or it’s getting worse
- You also have a fever, feel unwell, have weight loss you can’t explain, or have a history of cancer
- The pain is constant and severe at night, whatever position you’re in
- You’ve lost height or become more stooped, even without pain
The pain usually settles in weeks to months, but the weak bone behind it needs looking after for years.