Compression Fractures

What are Compression Fractures

Compression fractures are small breaks or cracks in the vertebrae, which are the bones constituting the spinal column. These fractures predominantly affect the vertebral body, which is the thick, rounded part located at the front of each vertebra. When the integrity of these bones is compromised, it leads to a weakening and potential collapse of the spine, which can affect posture.

The most common site for these fractures is in the thoracic region, particularly the lower thoracic area, though they can occur anywhere along the spine.

Symptoms

Compression fractures present a range of symptoms, which can vary in intensity from mild to severe. In some cases, individuals may not exhibit symptoms, and the fracture is only discovered during a medical screening.

• Back Pain: The primary indicator is back pain, which can emerge suddenly and persist for an extended period. This pain typically develops in the region between the shoulders and the lower back, often becoming more pronounced when standing or walking and lessening when lying down.
• Decreased Spinal Mobility: There can be a noticeable reduction in the ability to twist or bend, due to decreased flexibility and mobility in the spine.
• Changes in Posture: A prolonged compression fracture can lead to a hunched appearance, commonly referred to as a “dowager’s hump” or hunchback. This results from the curvature of the spine due to the compression of the vertebrae.
• Height Loss: As the vertebrae compress, there can be a reduction in height.
• Neurological Symptoms: Compression fractures can impinge on nerves, potentially causing tingling, numbness, and in severe cases, difficulties with walking.
• Bladder or Bowel Control Issues: In advanced and untreated cases, individuals may experience problems with bladder or bowel control.

Causes and Risk Factors

These fractures are frequently a result of immense pressure on the spinal vertebrae, causing the bones to break or crack. This can be due to various factors:

• Osteoporosis
  Osteoporosis results in bone weakening, increasing susceptibility to fractures. This risk is notably higher in people over the age of 50. In severe cases, even minor stresses like coughing or sneezing can lead to a fracture.
• Age-Related Bone Weakening
  As individuals age, their bone density decreases, making the vertebrae more prone to compression fractures. This is particularly notable in postmenopausal women and older men.
• Family History
  A genetic predisposition to osteoporosis can increase the likelihood of compression fractures.
• Past Injuries
  A history of spinal injuries or previous compression fractures can elevate the risk of future fractures.
  
• Certain Medical Conditions
  Certain medical conditions, such as cancer, can weaken the vertebrae and contribute to the risk of fractures. Cancerous tumours, especially those that metastasize to the spine, may weaken the vertebrae.
• Strenuous Activities or Traumatic Incidents
  Activities that put repetitive stress on the spine or traumatic events like falls and car accidents can also lead to compression fractures.

Non-Surgical Treatment Options

A range of non-surgical treatment options is available for compression fractures. These are often recommended for less severe fractures or for patients where surgery is not an option.

Pain Relief Medication

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can be used to alleviate pain. In some cases, prescription medications, including muscle relaxers, may be recommended by the spine specialist.

Back Braces

Special back braces can support the spine, helping to reduce movement and alleviate pain.

Medications to Strengthen Bones

Bisphosphonates, such as ibandronic acid and alendronic acid, can be prescribed to slow bone loss, stabilise the bones, and prevent further fractures.

Physical Therapy

A structured physical therapy programme can help improve mobility and strength, reducing the risk of future injuries.

Surgical Treatment Options

In cases where non-surgical treatments are insufficient or if the compression fracture is severe, surgical interventions may be necessary.

• Vertebroplasty
  This minimally invasive procedure involves injecting bone cement into the collapsed vertebra. The cement is used to stabilise the spine and may help in reducing pain. It can also prevent further collapse of the affected vertebra and maintain spinal alignment.
• Kyphoplasty
  Similar to vertebroplasty, kyphoplasty involves inserting a balloon device into the fractured vertebra. This balloon is then inflated to restore the height and shape of the vertebra before it is filled with bone cement. This procedure not only stabilises the vertebra but also aims to correct deformities in the spinal column.

Prevention Strategies

While not all compression fractures can be prevented, there are strategies to reduce the risk, particularly for fractures related to osteoporosis.

• Maintaining Bone Health Through Diet: A diet rich in calcium and vitamin D, along with supplements if necessary, can help maintain bone density.
• Regular Exercise: Physical activity, such as weight-bearing and muscle-strengthening exercises, has been associated with enhanced bone strength.
• Avoiding Excessive Alcohol Consumption and Smoking: Try to reduce alcohol consumption and quit smoking, as these habits can weaken bones and increase the risk of fractures.
• Implementing Fall Prevention Measures: Implementing measures to prevent falls, such as removing tripping hazards in the home, using non-slip mats, and ensuring adequate lighting, can reduce the risk of spine fractures.
• Regular Medical Checkups: Regular screenings for bone density, especially for those over 50 or with risk factors for osteoporosis, can help in early detection and management of bone weakening.