Understanding Vertebral Compression Fractures
A vertebral compression fracture (VCF) is a type of spinal fracture where a vertebra in the spine collapses, compressing its height and potentially causing significant pain and discomfort. Vertebral compression fractures most commonly occur in the thoracic (mid-back) and lumbar (lower back) regions and are often associated with conditions that weaken the bones, such as osteoporosis. These fractures can lead to a range of symptoms, from mild pain to more severe complications, and can impact posture, mobility, and overall quality of life.

What is a Vertebral Compression Fracture?
The spine is composed of individual bones called vertebrae, which are stacked to form a protective column around the spinal cord. Each vertebra is roughly cylindrical in shape and designed to support the body’s weight while allowing flexibility and movement. A vertebral compression fracture occurs when the front part of a vertebra collapses, causing it to lose height and creating a wedge-like shape. This collapse often happens suddenly due to weakened bone, which can be the result of various health conditions or physical trauma.
Causes of Vertebral Compression Fractures
Several factors can contribute to vertebral compression fractures, with the most common cause being weakened bone structure. Let’s explore some of the primary causes:
- Osteoporosis: Osteoporosis is a condition that weakens bones by reducing bone density, making them more fragile and susceptible to fractures. It is the leading cause of vertebral compression fractures, especially in older adults. In cases of severe osteoporosis, even minor movements like bending forward, lifting a small weight, or coughing can lead to a fracture.
- Trauma and Injury: While osteoporosis-related fractures are common, vertebral compression fractures can also occur due to high-impact trauma, such as a car accident, a fall from height, or a sports injury. In these cases, the force exerted on the spine exceeds its structural capacity, resulting in a fracture.
- Cancer and Metastasis: Some cancers, particularly those that metastasise (spread) to the bone, can weaken the vertebrae and make them more susceptible to fractures. Multiple myeloma, a type of blood cancer that affects bone marrow, and cancers that commonly spread to the spine (like breast, lung, or prostate cancer) can increase the risk of vertebral compression fractures.
- Bone Infections (Osteomyelitis): Though less common, infections in the spine or bones can weaken the vertebral structure, making it prone to fractures. Infections may spread from other areas of the body or result from procedures that introduce bacteria to the spinal region.
- Long-Term Use of Corticosteroids: Corticosteroid medications, often prescribed for inflammatory or autoimmune conditions, can weaken bone density over time. Prolonged use of these medications can lead to osteoporosis and an increased risk of fractures, including vertebral compression fractures.
- Age-Related Degeneration: As we age, the spine naturally undergoes wear and tear. Degeneration can weaken the vertebrae and the discs between them, which may contribute to fractures in older adults, particularly those with other risk factors like osteoporosis.
Symptoms of a Vertebral Compression Fracture
The symptoms of a vertebral compression fracture can vary significantly depending on the severity and location of the fracture. Some individuals may experience mild discomfort, while others may have more pronounced symptoms. Here are common symptoms to look out for:
- Sudden Onset of Back Pain: The most common symptom of a vertebral compression fracture is sudden, sharp back pain. This pain may develop immediately after a specific activity, such as bending or lifting, or it may appear suddenly without any obvious cause. In cases where osteoporosis is involved, even minor movements can trigger this pain.
- Pain that Worsens with Movement: Individuals with a compression fracture often find that their pain worsens with movement, such as standing or walking, and eases when lying down. The pain is typically localised around the fracture site but can sometimes radiate into other areas, depending on the location of the fracture.
- Height Loss: Over time, multiple vertebral compression fractures can lead to a noticeable reduction in height. This happens as the fractured vertebrae compress and collapse, causing the spine to shorten. It is not uncommon for individuals with multiple fractures to lose several centimetres in height.
- Kyphosis (Forward-Rounding of the Spine): In cases of multiple fractures, the spine can develop a forward curve known as kyphosis, resulting in a hunchbacked appearance. This occurs because the compressed vertebrae cause a forward tilt in the spine, affecting posture and balance. Kyphosis can also lead to additional discomfort, as it places strain on other parts of the spine and nearby muscles.
- Difficulty Breathing or Digestive Issues: Severe kyphosis resulting from multiple fractures can reduce the space within the chest cavity, potentially impacting lung function and causing difficulty breathing. It may also compress the abdominal cavity, which can lead to digestive issues, including bloating or constipation.
- Reduced Mobility and Flexibility: Individuals with vertebral compression fractures often experience limited mobility and may find certain movements, such as bending or twisting, painful or difficult. Reduced spinal flexibility can interfere with daily activities, impacting overall quality of life.
- Chronic Pain: While some vertebral compression fractures may heal over time, others can lead to chronic pain, particularly if multiple fractures are present. This pain may be due to changes in spinal alignment, strain on surrounding muscles, or nerve compression from the collapsed vertebra.
Types of Vertebral Compression Fractures
Not all vertebral compression fractures are the same, and understanding the type of fracture can help in grasping its implications on spinal health. Here are the main types of compression fractures:
- Wedge Fracture: The most common type of vertebral compression fracture is a wedge fracture, where the front of the vertebra collapses, creating a wedge shape. This type of fracture often leads to kyphosis as the vertebrae tilt forward.
- Burst Fracture: A burst fracture is more severe than a wedge fracture and occurs when the vertebra collapses in multiple directions. This can result from high-impact trauma, and the bone fragments may extend outward, increasing the risk of nerve or spinal cord injury.
- Crush Fracture: In a crush fracture, the entire vertebra loses height, rather than just the front portion as seen in a wedge fracture. This type of fracture can cause a more uniform collapse and may lead to pain and deformity.
Long-Term Effects of Vertebral Compression Fractures
Vertebral compression fractures can have long-lasting impacts, especially if multiple fractures occur over time. Below are some of the potential long-term effects:
- Spinal Deformity: Repeated compression fractures can lead to a pronounced spinal deformity, such as kyphosis. This forward rounding of the back can affect balance, posture, and even self-confidence. Severe kyphosis can place pressure on other vertebrae, leading to further fractures and a cycle of deformity.
- Chronic Pain and Discomfort: While some individuals may recover from a single fracture without long-term pain, others may experience chronic pain due to spinal changes, nerve irritation, or muscle strain. Chronic pain can limit physical activity, affecting overall health and quality of life.
- Reduced Mobility and Functional Limitations: Spinal fractures, especially if untreated, can lead to reduced flexibility and mobility. Daily activities such as bending, lifting, and even walking may become challenging, and certain physical activities may need to be avoided to prevent further damage.
- Increased Risk of Further Fractures: A vertebral compression fracture can weaken the structure of the spine, making it more susceptible to additional fractures. This is particularly relevant in individuals with osteoporosis, as weakened bones increase the likelihood of further injuries.
- Impact on Lung and Digestive Function: Severe kyphosis resulting from multiple compression fractures can reduce lung capacity by limiting the space within the chest cavity. This can cause shortness of breath, especially during physical activities. Similarly, compression of the abdominal cavity may lead to digestive discomfort and issues with bowel function.
Preventing Vertebral Compression Fractures
While not all vertebral compression fractures can be prevented, certain lifestyle changes and practices can reduce the risk, particularly for individuals at higher risk due to osteoporosis or other bone-weakening conditions:
- Strengthening Bone Health: Ensuring adequate calcium and vitamin D intake, along with regular exercise that includes weight-bearing activities, can help maintain strong bones. This is especially important for older adults and those with risk factors for osteoporosis.
- Engaging in Safe Movement Practices: Using proper lifting techniques, avoiding sudden or jarring movements, and practising good posture can reduce the risk of injury to the spine. Simple precautions can prevent minor injuries from escalating into fractures.
- Avoiding High-Risk Activities: For those with known bone density issues, it may be wise to avoid activities with a high risk of falls or impact, such as skiing or contact sports. Opting for low-impact activities can help protect the spine.
- Regular Screening for Osteoporosis: For individuals over the age of 50 or those with a family history of osteoporosis, regular bone density screenings can detect early signs of weakened bones, allowing for preventative measures to be taken before fractures occur.
Conclusion
Vertebral compression fractures are a significant spinal condition that can lead to pain, reduced mobility, and long-term health complications. Understanding the causes, types, and symptoms of these fractures can help individuals recognise early signs and make lifestyle adjustments to reduce the risk of further injury.