When Back Pain Means a Fracture

June 15, 2011
By: Stephanie Burke

Osteoporosis is called the "silent disease" because most people don't know they have it until the disease has really progressed -- often to the point of a fracture. Even then, most spinal fractures are dismissed as general back pain due to aging or a muscle strain. Spine fractures are serious business and can result in severe pain, spinal deformity (e.g., lost height, hunched back) and more serious medical conditions.

Recognizing a Spine Fracture

Most osteoporotic spine fractures (also called vertebral compression fractures) start with sudden back pain, usually after a pretty routine event that slightly strains or jars the back, like lifting something heavy or bending to pick something up off the floor. After a month or two, this acute pain usually subsides to more of an achy pain in a concentrated area of the back where the fracture occurred. Other clinical symptoms include: less pain when lying down, limited spinal mobility and height loss. For a more complete description of symptoms, please see Symptoms of a Vertebral Fracture.

Diagnosing a Spine Fracture

Unfortunately, only about one-third of all spine fractures are diagnosed. This is because spine fractures can be difficult to diagnose and may be missed on an x-ray, and because back pain complaints among elderly women are often dismissed as a general part of aging, such as simple muscle strain or arthritis. The diagnostic process for a spine fracture typically includes a complete medical history, physical exam and x-ray, and may include additional diagnostic tests such as a CAT scan or MRI. Osteoporosis is the leading cause of spine fractures, especially in women over age 50. Other causes of spinal fractures include trauma or cancer. Learn more in Diagnosing Vertebral Compression Fractures.

Treating a Spine Fracture

For spine fractures caused by osteoporosis, physicians usually recommend a two-pronged approach:

1. Treating the fracture itself to reduce pain and functional disability
   The first line of treatment for a spinal fracture is non-surgical care, such as rest, pain medication and a gradual return to mobility while the fracture heals. If the fracture does not heal well or causes severe pain and/or physical disability, surgical treatments may be recommended. The two most common surgical procedures for osteoporotic spine fractures are vertebroplasty and kyphoplasty.
• Vertebroplasty: This is a minimally invasive procedure performed through a small puncture in the patient's skin. Low viscosity cement is injected directly into the collapsed vertebral body under high pressure, with the goal of stabilizing the fracture and relieving the associated pain (caused by spinal bones rubbing together). Patients can usually go home the day of the procedure. Read more in Vertebroplasty after a Painful Spine Fracture.
• Kyphoplasty: This is also a minimally invasive procedure performed through a small puncture in the patient's skin. Unlike vertebroplasty, Kyphoplasty involves first inserting a balloon into the bone to create a cavity, then injecting high viscosity cement under low pressure into the space created by the balloon. Using a balloon is designed to help restore vertebral bone height (lessening deformity caused by the fracture) and stabilizes the fracture to reduce or eliminate the pain. Patients may usually go home the same day or the day after the procedure.
2. Treating the underlying osteoporosis to prevent additional fractures.
   The presence of one spinal fracture increases the risk of another fracture five-fold and is associated with increased mortality rates. Thus, most physicians recommend aggressive treatment for osteoporosis in patients who've experienced a fracture. Treatment for osteoporosis will likely include a combination of things, such as:
• A diet rich in calcium and vitamin D, including calcium and vitamin D supplements as needed to get adequate daily amounts of both. Learn more in Calcium is Needed for Strong Bones.
• Regular weight bearing exercise, such as walking, jogging, dancing, or stair climbing and strength training (depending on the patient's condition). About 30 minutes of low impact aerobic exercise 3 to 4 times weekly is generally recommended. Learn about one simple, yet highly effective, activity in Exercise Walking for Better Back Health.
• Osteoporosis medications that slow bone loss or increase bone formation. A physician may also prescribe regular bone density testing, usually a DEXA scan that passes low energy x-rays through a bone, to assess how well the medications and overall treatment plan are working to increase bone density. Read more about the DEXA scan in Diagnosis and Treatment for Osteoporosis.