Understanding Spine Fractures from Weakened Bone
A vertebral compression fracture happens when one of the bones of the spine (a vertebra) collapses, usually in the middle or lower back. Most are caused by osteoporosis, which thins the bones so that even minor strain, like lifting a grocery bag, coughing, or a small fall, can cause a fracture. Many heal with time, bracing, and pain control over 6 to 12 weeks. For severe pain that doesn't settle, a minimally invasive procedure can stabilize the bone.
Causes
Osteoporosis, the most common cause, especially in older adults and women after menopause.
Long-term steroid use, which weakens bone.
Trauma, such as a fall from height or a car accident.
Cancer that has spread to the spine, or multiple myeloma.
Symptoms
Sudden back pain, often in the mid or lower back, that worsens with standing or walking and eases when lying down.
Pain with twisting, bending, or coughing.
Loss of height over time.
A forward-curved upper back (kyphosis).
Some fractures cause little or no pain and are found incidentally.
Seek immediate medical care if: You have new leg weakness, numbness, or loss of bladder or bowel control, or back pain with fever, unexplained weight loss, or a history of cancer.
Imaging Studies to Consider
X-rays show the fracture and how much height the vertebra has lost.
MRI shows whether a fracture is new or old (bone swelling indicates a recent fracture) and is important before any procedure.
CT scan shows bone detail.
A bone density (DEXA) scan evaluates osteoporosis.
Physical Therapy, Home Exercise & Other Conservative Techniques
Physical Therapy
Posture training and back extensor strengthening, once acute pain allows.
Balance training to prevent falls.
Home Exercise Program
Gentle walking as tolerated.
Back extension exercises; avoid forward bending and twisting under load.
Other Studied Techniques
Short-term bracing for comfort.
Fall-proofing the home.
Interventional Treatment Options
Vertebral augmentation (kyphoplasty or vertebroplasty): Bone cement is injected into the fractured vertebra through a needle under x-ray guidance, stabilizing the fracture and often reducing pain quickly. Kyphoplasty first uses a small balloon to create space. Studies have shown mixed results, with the clearest benefit in recent, painful fractures confirmed on MRI.
Medial branch blocks or facet injections: For ongoing pain from nearby joints after the fracture heals.
Surgical referral: For fractures causing spinal instability or nerve compression.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
Neuromodulation is not a standard treatment for compression fractures. It may be considered for chronic back or leg pain that persists after a fracture has healed, in select patients.
Evidence Base: Guidelines & Levels of Evidence
Kyphoplasty: Level I · FREE randomized trial (Wardlaw et al., Lancet 2009): better pain and function than nonsurgical care
Vertebroplasty: Level I (mixed) · VERTOS II (Klazen et al., Lancet 2010) favorable; sham-controlled trials (Buchbinder et al. and Kallmes et al., N Engl J Med 2009) found no difference
Osteoporosis treatment (prevention of further fractures): Level I · Endocrine Society and other society guidelines
Bracing: Level II–III · Limited randomized evidence
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Pain Psychology Techniques
Cognitive behavioral therapy (CBT) for fear of movement and falling.
Graded activity pacing.
Relaxation training and diaphragmatic breathing.
Mindfulness-based stress reduction.
Non-Opioid Medication Options
Anti-inflammatory and analgesic options
Acetaminophen.
NSAIDs used cautiously, with attention to kidney, stomach, and heart risks.
Other options
Calcitonin is sometimes used briefly for acute fracture pain.
Lidocaine patches over the painful area.
Bone health
Calcium, vitamin D, and osteoporosis medications (such as bisphosphonates) to lower the risk of new fractures. We coordinate with your primary care doctor or endocrinologist.
Related Procedures
Related Conditions
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
