Spine · Conditions

Compression Fractures of the Spine: Definition, Causes, Risk Factors, and Complications

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Compression fractures of the spine are breaks that occur in the vertebrae under the force of pressure.

Compression fractures of the spine are breaks that occur in the vertebrae under the force of pressure. Your vertebrae are the bones that make up your spine. The spinal fracture is often defined based on its location along the spine. These breaks most commonly happen in the middle (thoracic) and lower (lumbar) areas of the spine.

A spinal fracture happens when the vertebrae become pressed together because of trauma. In most situations, the amount of force necessary to break a spinal vertebra is substantial, but in some situations, such as in people who have cancer, or in the elderly, the vertebrae become fragile and spinal fractures can occur with very little force. While it most often occurs in the lower back area, it can happen in any area of the spine.

Multiple compression spinal fractures are a result of fractures affecting more than one vertebra. These spinal fractures lead to a forward rounding of a person’s spine, thus making them look shorter or causing kyphosis. Elderly people are the main victims of spinal fractures, although the prevalence is very high among women.

The pain caused by a compression fracture of the spine varies depending on the patient and the location of the spinal fracture. Some people complain about experiencing severe pain, while others don’t show any signs of pain at all. Severe spinal fractures of the spine can lead to a forward curvature of the spine, a condition known as kyphosis, or dowagers hump.

Osteoporosis is the common cause of compression fractures of the spine and it leads to the following types of spinal fractures:

  • Wedged fracture – the compression fracture happens in the anterior of the vertebra and it causes the bone in front of your spine to collapse, but this doesn’t change the back of the same bone. As a result, a wedge-shaped vertebra is formed.
  • Crush fracture – spinal fractures happen in cases where the whole bone breaks.
  • Burst fracture – people with this type of fracture are known to lose some height in both the posterior and anterior walls of their vertebral body making this crush fracture very distinct as height loss from other spinal fractures happen in the anterior of the vertebra. Thus, it is very important to make this distinction, as burst spinal fractures can lead to neurologic compromise or progressive deformity.

These three spinal fractures can also be classified as either stable or unstable.

  • Stable fractures are unlikely to undergo any further changes and therefore there is little possibility of the spinal fractures creating additional damage.
  • Unstable fractures are more likely to undergo further changes. These changes can cause damage to the tissues and nerves, or lead to permanent spinal deformity.

Causes of Spinal Fractures

Compression fracture of the spine can be caused by various conditions including trauma, osteoporosis and by other diseases which affect the bones.

Osteoporosis

Osteoporosis is a bone disease which increases the risk of spinal fractures because it decreases the density of bone tissue. In osteoporosis, a fracture can occur with little or even no traumatic event. People who have severe osteoporosis may sustain a spinal fracture of the spine while carrying out simple activities such as picking something up from the floor or getting out of bed.

Sneezing or coughing can cause spinal fractures in these people. In cases of moderate osteoporosis, increased trauma is usually needed to cause a vertebral compression fracture, such as trying to lift something heavy. A fall may cause a spinal fracture in a person with moderate osteoporosis.

Osteoporosis typically occurs in women who have gone through menopause, but elderly men are also at risk, as well as people who have used steroid medications, like prednisone, over long periods of time.

Trauma

People whose bones are healthy generally sustain compression spinal fractures of the spine with severe traumatic accidents, such as sports injuries, motor vehicle accidents, or in hard falls in which they land on their buttocks or their feet.

Pathologic spinal fracture

A pathologic fracture is one that occurs because of a preexisting condition or disease at the site of the fracture. Most of the time, this type of compression fracture of the spine occurs due to a bone tumor. Cancer can spread from sites such as the lungs, breast, or prostate to the bone and destroy part of the vertebra. The compression fracture of the spine then occurs in the bone that has been weakened by the tumor.

Metastatic disease

The term metastatic is used to describe a condition where cancer cells spread to other parts of the body. The spinal bones are known to allow different types of cancer to spread to the body. A spinal fracture which happens without any apparent reason can be a sign of cancer spreading through the spine. Cancer can destroy some parts of the spinal bones, weakening them to the point where they collapse. Such spinal fractures are a clear indication that there is something happening internally which is causing harm to the bones.

Other conditions can also lead to pathologic spinal fractures and compression fractures of the spine, such as bone infections (osteomyelitis) and Paget's disease.

However, there are some underlying risk factors which can also lead to spinal fractures, that is, if they go unchecked. There are two groups of people who are at the risk of developing spinal fractures. These include:

  • Osteoporosis patients
  • People with cancer which has spread to their bones.

People diagnosed with some types of cancer, including multiple lymphoma and myeloma should be monitored for signs of spinal fractures, but a spinal fracture can be the first indication that an individual has cancer.

However, some people are at a higher risk of developing spinal compression fracture because of:

  • Race – both Asian and white women have a higher risk of developing the condition.
  • Age – the chances of spinal fractures are higher for elderly women.
  • Weight – thin people are at a higher risk of fracturing their spinal bones.
  • Early menopause – any woman who undergoes an early menopause has a higher chance of getting osteoporosis.
  • Smoking – smokers lose their bone thickness faster compared to nonsmokers, and this puts them at risk of spinal compression fractures.

Prevalence

Spinal compression fractures occur most commonly in people who have osteoporosis. They affect about 750,000 people each year. An estimated 25% of all women past the age of menopause in the United States suffer from compression fractures of the spine. It is estimated that 40% of women who are at least 80 years old have the condition. It also affects men. The prevalence of compression fractures of the spine increases with age.

In the US alone, close to 10 million people have osteoporosis, and it is estimated that 34 million people are affected by low bone mass and they are at a higher risk of developing compressed fractures of the spine. 80% of the 10 million Americans affected by osteoporosis are women and 20% are men. The mortality rate for women with spinal fractures is 15% higher compared to those without the fractures.

Research has shown that people who have ever suffered a spinal fracture because of osteoporosis are very likely to develop a second spinal compression fracture. These spinal fractures can still be present in an individual, but show no symptoms,or minor symptoms. However, the individuals are still at risk of developing additional compression fractures to their spine.

Although the prevalence of compression fracture to the spine is very low in elderly men, the condition poses a significant health concern for them. In the US, the age group of elderly men aged 65 and above is growing very fast, meaning, the prevalence rate of spinal fractures in this group is likely to increase.

The prevalence rate of spinal fractures caused by osteoporosis is very high among white women as statistics show that 50% of these women will sustain a fracture at some point in their lifetime. Spinal fractures caused by osteoporosis are said to affect women 6 times more than they affect men. Osteoporotic spinal fractures to the spine have very adverse effects on the elderly as they are the main causes of disability and related injuries.

Estimates show that there are 550,000 spinal fractures related to osteoporosis every year in the US and 120,000 spinal fractures in the UK every year. Also, statistics indicate that there were approximately 1.4 million compression fracture cases in 2002 and most of these cases were reported to have happened in Europe.

Spinal fracture
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