Compression Fractures: Symptoms, Types, Causes and Treatment

Compression fractures are a significant health concern, especially among older adults. These fractures, most commonly affecting the spine, can lead to pain, disability, and a substantial reduction in quality of life. Understanding their symptoms, types, causes, and treatment options is critical for early diagnosis and effective management. This article provides a comprehensive, evidence-based overview of compression fractures, synthesizing the latest research to guide patients, caregivers, and healthcare professionals.

Symptoms of Compression Fractures

Compression fractures often present with a range of symptoms that can vary in severity and impact daily life. Many people may not initially recognize the signs, which can lead to delays in diagnosis and treatment. Understanding these symptoms is essential for timely intervention and improved outcomes.

Symptom	Description	Impact	Source(s)
Acute Pain	Sudden, intense back pain at fracture site	Limits movement, daily tasks	1, 2, 7
Chronic Pain	Persistent pain after initial injury	Long-term disability	1, 4, 13
Height Loss	Noticeable reduction in stature	Body image, breathing issues	1, 4
Kyphosis	Curved upper back (hunchback)	Mobility, self-esteem	1, 4, 7
Other Symptoms	Nausea, abdominal/chest pain, sleep issues	General well-being	2, 1

Table 1: Key Symptoms

Understanding Common Symptoms

Compression fractures are frequently characterized by acute, localized back pain, often arising suddenly after minimal trauma or even spontaneously. This pain is typically severe and lasts 4–6 weeks, significantly limiting mobility and daily activities 1, 2. In many cases, the pain may radiate to the flanks or front of the body, though radiation into the legs is uncommon 2.

Chronic pain may arise, especially in individuals with multiple fractures or underlying bone loss. Chronic discomfort often stems not just from the fracture itself, but also from resulting spinal deformities or secondary osteoarthritis 1, 4, 13.

Physical Changes and Functional Impact

Height loss is a classic sign, resulting from the collapse of the vertebral body. As fractures accumulate, patients may notice a measurable reduction in their height. This leads to changes in posture, such as thoracic kyphosis (rounded upper back) and a protuberant abdomen, both of which can impact self-esteem and body image 1, 4, 7.

Other accompanying symptoms can include:

• Nausea and abdominal pain (often due to reduced abdominal space)
• Chest pain
• Early satiety (fullness)
• Sleep disturbances
• Reduced exercise tolerance
• Depression and anxiety due to chronic pain and physical limitations 1, 2

Psychological and Quality of Life Effects

Compression fractures can have profound psychological effects. Many patients experience loss of self-esteem, fear of further injury, and depressive symptoms. The pain and physical limitations may make self-care difficult, leading to increased dependence on others 1.

Types of Compression Fractures

Compression fractures are not all the same. They can be classified based on their location, cause, and the specific pattern of bone collapse. Recognizing the different types helps guide treatment decisions and predict outcomes.

Type	Description	Stability/Severity	Source(s)
Wedge Fracture	Front of vertebra collapses more than back	Generally stable	4, 7, 13
Burst Fracture	Vertebra collapses in all directions	May be unstable	4, 13
Pathologic	Caused by disease (e.g., cancer, infection)	Variable	8, 9
Fragility	Result from low-energy trauma, usually bone weakness	Often stable	6, 11

Table 2: Types of Compression Fractures

Wedge Compression Fractures

The wedge fracture is the most common type, particularly in osteoporotic individuals. Here, the front of the vertebral body collapses, creating a wedge shape. These fractures are usually stable, meaning the spinal cord is not at risk, but they can still lead to significant pain and deformity 4, 7, 13.

Burst Fractures

Burst fractures are more severe. The vertebral body collapses in all directions, sometimes sending bone fragments into the spinal canal. This type of fracture can threaten spinal cord integrity and may require surgical intervention if there is neurological compromise or instability 4, 13.

Pathologic and Fragility Fractures

Pathologic fractures occur when the vertebral body is weakened by diseases like cancer or infection. MRI can help differentiate these from osteoporotic fractures by identifying features such as involvement of the pedicles, posterior elements, or the presence of masses 8, 9.

Fragility fractures are typically seen in older adults and result from low-energy trauma, such as a fall from standing height. These are closely linked to osteoporosis and other conditions that weaken bone 6, 11.

Causes of Compression Fractures

Understanding why compression fractures occur is crucial for prevention and targeted treatment. The causes can be broadly categorized as traumatic, osteoporotic, or pathologic, each with distinct risk factors.

Cause	Typical Patient Profile	Mechanism of Injury	Source(s)
Osteoporosis	Older adults, postmenopausal women	Low-energy trauma, spontaneous	7, 9, 11
Trauma	Any age, younger adults	High-energy accident, fall	4, 9, 13
Malignancy	Cancer patients	Bone weakened by tumor	8, 9
Infection	Immunocompromised, history of infection	Bone destruction by pathogen	8, 9

Table 3: Causes of Compression Fractures

Osteoporotic Fractures

The most common cause of compression fractures is osteoporosis, a condition marked by decreased bone density and strength. Postmenopausal women are particularly at risk due to hormonal changes that accelerate bone loss. Often, even minor stresses—such as bending, lifting, or coughing—can cause fractures in these fragile bones 7, 9, 11.

Traumatic Fractures

Younger individuals are more likely to experience compression fractures due to trauma, such as car accidents, sports injuries, or significant falls. In these cases, the force of impact exceeds the strength of healthy bone, resulting in fracture 4, 9, 13.

Pathologic Causes: Malignancy and Infection

Compression fractures can also result from underlying disease:

• Malignancy: Cancers that metastasize to bone (e.g., breast, prostate, lung, thyroid) or primary bone tumors weaken the structure, making it prone to fracture, sometimes with minimal or no trauma 8, 9.
• Infection: Spinal infections (osteomyelitis, discitis) destroy bone tissue, undermining its integrity and causing collapse. MRI features such as contiguous vertebral involvement and abscess formation help distinguish these cases 8, 9.

Risk Factors and Predisposing Conditions

Other factors can increase the risk of compression fractures:

• Long-term corticosteroid use
• Smoking and excessive alcohol intake
• Sedentary lifestyle
• Poor nutrition (especially low calcium and vitamin D)
• Previous fractures (especially of wrist or hip) 2, 11

Treatment of Compression Fractures

Treating compression fractures aims to relieve pain, restore function, prevent further fractures, and address underlying bone health. Management strategies range from conservative measures to advanced surgical techniques.

Approach	Key Features	When Used	Source(s)
Conservative	Rest, pain control, bracing, physical therapy	Most stable fractures	11, 13
Pharmacologic	Osteoporosis meds (bisphosphonates, calcitonin)	To prevent future fractures, manage pain	11, 12
Minimally Invasive	Vertebroplasty, kyphoplasty	Persistent pain, failed conservative care	7, 10, 14
Surgery	Decompression, stabilization	Unstable fracture, neurologic deficit	11

Table 4: Treatment Approaches

Conservative Management

Most compression fractures, especially those due to osteoporosis and without neurological symptoms, are treated conservatively:

• Rest and Activity Modification: Short-term rest may help, but early mobilization is encouraged to prevent complications 13.
• Pain Management: Analgesics (acetaminophen, NSAIDs, short-term opioids) are commonly used. Calcitonin may offer additional pain relief in the acute phase 11, 12.
• Bracing: Spinal braces can provide support, reduce pain, and help maintain alignment while the fracture heals. Studies show that bracing, combined with physical therapy, is effective and well-tolerated 13.
• Physical Therapy: Focuses on restoring function, improving strength, and teaching safe movement techniques 13.

Pharmacologic Therapy

Addressing the underlying bone weakness is vital:

• Bisphosphonates and Other Osteoporosis Medications: These drugs help strengthen bone and reduce the risk of future fractures, though they do not heal the current fracture 11, 12.
• Calcium and Vitamin D Supplementation: Supports bone metabolism and is recommended for most patients 11.
• Calcitonin: May be used short-term to reduce acute pain following fracture 12.

Minimally Invasive Procedures

For patients with persistent, severe pain or those who do not improve with conservative therapy, minimally invasive procedures are available:

• Vertebroplasty: Involves injecting bone cement into the fractured vertebra to stabilize it and reduce pain. It is quick and widely used but may carry risks such as cement leakage 7, 10, 14.
• Kyphoplasty: Similar to vertebroplasty, but uses a balloon to restore vertebral height before cement injection. This can improve spinal alignment and may reduce complications 10, 14. Kyphoplasty is particularly effective when performed within three months of fracture onset 10.
• Note: Some guidelines recommend caution with vertebroplasty due to mixed evidence on long-term benefit 12.

Surgical Intervention

Surgery is reserved for rare cases with:

• Unstable fractures
• Spinal cord or nerve compression
• Progressive deformity Procedures may include decompression and spinal stabilization 11.

Addressing Underlying Osteoporosis and Prevention

• Screening for osteoporosis and initiating appropriate therapy is essential to prevent additional fractures.
• Lifestyle modification: Encourage weight-bearing exercise, smoking cessation, and adequate nutrition 11.

Conclusion

Compression fractures are a common, often debilitating health issue, especially in older adults with osteoporosis. Their symptoms, types, causes, and treatment options are diverse and require a tailored, multidisciplinary approach for optimal outcomes.

Key takeaways:

• Compression fractures most commonly present with acute back pain, height loss, and spinal deformity, but can also cause systemic and psychological symptoms.
• The main types include wedge, burst, pathologic, and fragility fractures, each with unique features and management implications.
• Osteoporosis is the leading cause, but trauma, cancer, and infection are important contributors.
• Most fractures are managed conservatively, but persistent or severe cases may benefit from minimally invasive procedures like vertebroplasty or kyphoplasty.
• Preventing future fractures by treating underlying osteoporosis and promoting bone health is crucial in all patients.

A comprehensive, patient-centered approach—combining timely diagnosis, individualized treatment, and proactive prevention—offers the best chance for recovery and improved quality of life.