Vertebral fractures are usually followed by acute back pain and may lead to chronic pain, deformity (thoracic kyphosis, commonly referred to as a dowager's hump), loss of height, crowding of internal organs, and loss of muscle and aerobic conditioning due to lack of activity and exercise.
The main clinical symptoms of vertebral fractures typically include one or a combination of the following:
- Sudden onset of back pain
- Worse pain while standing or walking
- Less intense pain while lying on one's back
- Limited spinal mobility
- Height loss
- Deformity and disability
Because the majority of damage is limited to the front of the vertebral column, the fracture is usually stable and rarely associated with any nerve or spinal cord damage.
A common problem with a vertebral fracture is that it is not recognized or accurately diagnosed. Instead, the patient's pain is often just thought of as general back pain — such as from a muscle strain or other soft-tissue injury — or as a common part of aging. As a result, about two-thirds of the vertebral fractures that occur each year are not diagnosed and therefore are not treated.
Causes and Risk Factors
Osteoporosis is by far the most common cause of vertebral compression fractures, especially in women over age 50. It is more common than most people think in people between the ages of 40 and 50, and it is reasonably common in men over age 50.
Osteoporosis causes bones to thin and become brittle and weak. The thinning bones can collapse during normal activity, leading to a spinal fracture. These compression fractures can cause a great deal of pain and can permanently alter the shape and strength of the spine.
Spinal fractures due to osteoporosis often occur while a person is doing something that causes relatively minor trauma to the spine, such as opening a window, suffering an insignificant fall or twisting while lifting.
Advanced cases of osteoporosis can lead to a vertebral fracture being caused by routine activities that normally would not cause trauma, such as sneezing, coughing or turning over in bed.
Trauma to the spinal vertebrae also can lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident or any event that stresses the bones in the spine past its breaking point.
Tumors also can weaken the spinal vertebrae to the point where they may fracture. It is not uncommon for metastatic cancer that starts in another part of the body to spread to bones in the spine.
A compression fracture of the spine that appears for little or no reason may be the first indication that an unrecognized cancer has spread to the spine. Cancer or multiple myeloma should be considered in patients who also have hypercalcemia, otherwise unexplained anemia, weight loss or proteinuria.