Vertebral Compression Fracture

Each vertebra has a solid, weight-bearing block at the front (the vertebral body) and a ring of bone behind it that protects the spinal cord and nerves. A compression fracture affects the vertebral body — the part that carries most of the load. Because the front of the body often collapses more than the back, the vertebra becomes wedge-shaped, and if several vertebrae are affected the spine can gradually curve forwards. Compression fractures are most common at the junction between the stiff chest section and the more mobile lower back (around the bottom of the ribcage), where mechanical stresses are highest.

There are three broad causes. The most common, especially in older adults, is osteoporosis — a thinning and weakening of the bones that makes them liable to fracture with little or no trauma, sometimes from something as ordinary as a cough, a bend or a minor stumble. The second is injury: a fall from height, a road traffic collision or a sporting accident can compress a healthy vertebra, and this is the usual cause in younger people. The third, less common but important, is an underlying weakness of the bone from another disease — most often a cancer that has spread to the spine, or a blood cancer such as myeloma. Recognising which of these is responsible matters, because it changes both the treatment and the wider care.

Doctors describe these fractures by their shape and their stability. In terms of shape, the vertebra may be wedged (collapsed at the front), biconcave (dished in the middle) or crushed (flattened throughout). More important for treatment is whether the fracture is stable or unstable. A stable fracture keeps the spine's overall alignment and does not threaten the nerves; an unstable one involves more of the vertebra and may allow abnormal movement or press on the spinal cord. Spinal surgeons often use a classification system (the AO Spine system) that groups injuries into compression injuries, injuries that tear the supporting ligaments, and the most severe injuries where the spine is displaced. This helps decide whether an injury can be managed simply or needs surgery.

The most common symptom is back pain, which may come on suddenly — sometimes after a trivial movement — and is often felt in the middle or lower back. The pain is typically worse on standing, walking or bending and eased by lying down. Over time, and particularly when several vertebrae are affected, people may notice a loss of height and a gradual stooping of the upper back. Not every compression fracture causes symptoms, however; some are painless and are discovered incidentally on imaging performed for another reason.

While most compression fractures are not emergencies, certain features do require prompt medical assessment: weakness, numbness or pins-and-needles in the legs, problems with bladder or bowel control, or severe pain following major trauma. Fractures accompanied by unexplained weight loss, night pain, fever, or a history of cancer also need careful evaluation, because they may point to an underlying disease rather than simple osteoporosis. Any of these should prompt urgent medical review.

A plain X-ray often shows the collapsed vertebra and any loss of height. A CT scan gives more detail of the bone and is useful for assessing stability after injury. An MRI scan is particularly helpful because it can tell a recent, still-healing fracture from an old one, and can raise the suspicion of an underlying tumour or infection. When osteoporosis is suspected, a bone density (DEXA) scan measures bone strength, and blood tests may be arranged to look for contributing conditions. Choosing the right combination of tests allows the team to confirm the fracture, judge its age and stability, and identify the underlying cause.

Most vertebral compression fractures, particularly stable osteoporotic ones, are managed without surgery, and the majority heal over a period of weeks to a few months. Non-surgical care focuses on controlling pain with medication, staying as active as is comfortable to avoid the complications of prolonged bed rest, and physiotherapy to rebuild strength and posture. Back braces are sometimes used to ease pain and support the spine, although the evidence that they change the long-term outcome is limited and their use varies between clinicians. Where osteoporosis is the cause, treating the underlying bone weakness is a central part of care to reduce the risk of further fractures.

Two minimally invasive procedures are sometimes offered for painful osteoporotic fractures that are not settling: vertebroplasty, in which surgical cement is injected into the fractured vertebra to stabilise it, and kyphoplasty, in which a small balloon is first used to create a space and partly restore height before the cement is placed. Their role is genuinely debated. Some high-quality trials, including sham-controlled studies, found little or no benefit over a placebo procedure, while others — particularly in people treated early for severe, acute pain — reported meaningful pain relief. Because of this mixed evidence, guidance such as that from NICE supports their use only in carefully selected patients whose pain is severe and not responding to other measures. The decision is individual and involves weighing the possible benefit against the small risks of the procedure.

Open surgery is reserved for the minority of compression fractures that are unstable, that are pressing on the spinal cord or nerves, or that are causing a significant and worsening spinal deformity. In these situations, surgery aims to relieve pressure on the nerves and to stabilise the spine, often using screws and rods. The specific operation depends on the level and pattern of injury, the underlying bone quality and the person's overall health.

The outlook for a single, stable compression fracture is generally good: pain usually improves over several weeks as the bone heals, and many people return to their normal activities. Recovery can be slower in older people and where the bone is weak. An important point is that having one osteoporotic vertebral fracture increases the risk of further fractures, which is why identifying and treating the underlying osteoporosis is so important. Attention to bone health, balance and fall prevention can meaningfully reduce that future risk.

When a compression fracture is caused by thinning bones, the fracture itself is a warning sign, and preventing the next one becomes a priority. This usually involves assessing and treating osteoporosis, ensuring adequate calcium and vitamin D, encouraging safe, weight-bearing activity, and reducing the risk of falls at home. Our osteoporotic vertebral fracture page covers this in more detail.

Myth: "A spinal fracture always needs surgery." Fact: Most compression fractures, especially stable osteoporotic ones, heal without surgery.

Myth: "Bed rest is the best treatment." Fact: Prolonged bed rest can cause complications; staying as active as comfortable generally aids recovery.

Myth: "Cement procedures are a guaranteed cure for the pain." Fact: The evidence is mixed, and they are used selectively rather than for every fracture.

Myth: "A painless spine means healthy bones." Fact: Some osteoporotic fractures are painless; a fracture can be the first sign of thinning bones.

This page is for general education and does not replace an individual assessment. Treatment depends on a person's specific symptoms, examination findings, imaging findings and overall health, and should always be discussed with a suitably qualified healthcare professional.

The spine is a column of bones called vertebrae, stacked one on top of another and separated by cushioning discs. A vertebral compression fracture happens when the main block-shaped part of a vertebra — the vertebral body — is crushed and loses height, most often at the front, giving it a wedge shape. These are among the most common fractures of the spine. In older people they frequently result from thinning of the bones (osteoporosis) and can occur with very little force; in younger people they usually follow a significant injury. Some cause sudden, severe back pain, while others are surprisingly silent and are found by chance on a scan. This page explains why these fractures happen, how they are assessed, and what the current evidence says about treatment and recovery. Where the fracture is due to osteoporosis, our dedicated osteoporotic vertebral fracture page covers bone health in more detail.

• —Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-2037. doi:10.1097/BRS.0b013e3182a8a381
• —Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568. doi:10.1056/NEJMoa0900429
• —Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569-579. doi:10.1056/NEJMoa0900563
• —Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408-1416. doi:10.1016/S0140-6736(16)31341-1
• —Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085-1092. doi:10.1016/S0140-6736(10)60954-3
• —Firanescu CE, de Vries J, Lodder P, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018;361:k1551. doi:10.1136/bmj.k1551
• —National Institute for Health and Care Excellence (NICE). Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. Technology appraisal guidance TA279. 2013.
• —Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues. Global Spine J. 2017;7(1):71-82. doi:10.1177/2192568216664713
• —Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-164. doi:10.1016/j.spinee.2012.10.041
• —Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V. Conservative management of patients with an osteoporotic vertebral fracture: a review of the literature. J Bone Joint Surg Br. 2012;94(2):152-157. doi:10.1302/0301-620X.94B2.26894
• —Chang V, Holly LT. Bracing for thoracolumbar fractures. Neurosurg Focus. 2014;37(1):E3. doi:10.3171/2014.4.FOCUS1477
• —Alexandru D, So W. Evaluation and management of vertebral compression fractures. Perm J. 2012;16(4):46-51. doi:10.7812/TPP/12-037
• —Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531-1542. doi:10.1007/s00198-017-3909-3
• —McCarthy J, Davis A. Diagnosis and Management of Vertebral Compression Fractures. Am Fam Physician. 2016;94(1):44-50. (PMID: 27386723)
• —Kweh BTS, Lee HQ, Tan T, et al. The role of spinal orthoses in osteoporotic vertebral fractures of the elderly population: a review. Global Spine J. 2021;11(6):975-981. doi:10.1177/2192568220948035
• —Guideline note: NICE guidance reviewed — TA279 (percutaneous vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures). AO Spine thoracolumbar classification used for injury description. No stand-alone AAOS clinical practice guideline specific to vertebral compression fracture was identified at the time of writing.

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.