Osteoporosis: Fracture Symptoms

By: Scott Boden, MD
May 11, 2005

The main clinical symptoms of vertebral fractures typically include one or a combination of the following symptoms:

1. Sudden onset of back pain

2. Standing or walking will usually make the pain worse

3. Lying on one’s back makes the pain less intense

4. Limited spinal mobility

5. Height loss

6. Deformity and disability

As a general rule, a compression fracture should be suspected in any patient over the age of 50 with acute onset of back pain. For women, especially those with risk factors for osteoporosis, many physicians believe that a vertebral fracture should be suspected in any women over age 45 with sudden onset of back pain. In addition, sometimes a compression fracture in the spine may not cause any back pain or other symptoms. Therefore, even if there is not back pain, middle age or elderly persons (especially women) need to be concerned about potential fractures if there is height loss, limited ability to twist and bend the back, and/or deformity that develops in the spine.

Typical progression of symptoms from an osteoporosis fracture

When osteoporosis results in a vertebral fracture, it is usually marked by the sudden onset of back pain. Most patients diagnosed with a compression fracture in the spine describe the onset of pain immediately after a fairly routine activity that slightly strains or jars the back, such as:

1. Lifting—opening a window or picking up a bag of groceries

2. Bending—picking something up off the floor

3. Falling—jarring the spine by missing a step or slipping on ice.

For people with very advanced osteoporosis, the fracture can even occur with extremely minor activity, such as sneezing, coughing, getting in or out of the bathtub, or simply turning over in bed.

The pain from an osteoporotic spinal fracture typically lasts about four to six weeks as the bone heals, after which most patients report that the more severe pain has subsided and has turned into more of a chronic, achy pain concentrated in the area of the back where the fracture occurred. This pain will usually get better after a few weeks, but for some people it can continue for several months. Additionally, some patients experience back pain long after the fractured bone has healed due to changed mechanics in the back and possibly due to inactivity.

The above describes the course of events that is experienced by most patients with a vertebral compression fracture. However, not everyone has a typical experience. For example, if the bone collapses gradually rather than due to an activity, the pain will usually be more gradual and mild. Also, some patients with vertebral fractures report that they felt no back pain or other symptoms. For others, instead of pain the symptoms of deformity that start to show up after multiple fractures may be the patient’s first indication that he or she has vertebral fractures from osteoporosis.

Symptoms of multiple vertebral fractures

Some patients experience multiple vertebral compression fractures, or successive crush fractures (when the entire vertebra breaks, instead of just the front part). In fact, once one vertebral compression fracture has occurred, the risk of subsequent fractures is substantially higher. This condition can lead to height loss and increased thoracic kyphosis (hunching forward at the upper back) and development of dowager's hump. Symptoms of multiple fractures in the spine may include one or a combination of the following:

1. Height loss. As the vertebrae cave in, each vertebra tends to lose at least 15-20% of its height. Thus, with successive fractures, the individual may lose a noticeable amount of height. This loss of stature changes the musculature in the back and can cause pain from muscle fatigue that can continue after the bone fracture has healed.

2. Thoracic kyphosis (dowager’s hump, or hunched back). The fracture usually occurs in the front of the vertebra and leaves the height at the back of the vertebra unchanged, resulting in a wedge-shaped bone in the spine. With multiple vertebral fractures, as the front of the collapsed vertebrae fuse together, the spine bends forward, causing a kyphotic deformity and hunched over appearance.

3. Bulging abdomen. As the vertebral fractures cause the patient’s spine to shrink in height, his or her abdominal contents are compressed into less vertical space. As a result, the abdomen can bulge out, causing clothes not to fit properly and an appearance of gaining weight, even though the patient has not put on weight.

4. Hip pain. Patients with multiple vertebral compression fractures may complain about discomfort or pain in their hips, especially the top of the hip bone. This occurs because, due to the shortened spine, the bottom of the patient’s rib cage may rub against the top of the patient’s hip bones (iliac crests).

5. Gastrointestinal complaints. The shortened spinal column may also compress the stomach, causing weight loss (because the patient feels full after eating small amounts), constipation, or other problems.

6. Neck pain. Patients with severe thoracic kyphosis may be so far hunched forward that they have to extend their necks in order to look forward, which can result in neck pain.

In general, crowding of internal organs can be a serious side effect of multiple compression fractures. For example, in severe cases, the trunk of the body may be so compressed that lung function is compromised.