What is a vertebral compression fracture?
A vertebral compression fracture (VCF) occurs when one of the bones in the spine, or vertebrae, collapses. This usually happens due to excessive pressure the bone cannot withstand. In the elderly, this is typically due to osteoporosis, which causes low bone mass and increased fragility. These fractures often affect the thoracic spine, particularly the thoracolumbar junction. Unlike traumatic fractures, osteoporotic VCFs can result from minor movements like twisting or coughing. The collapse is usually in the front of the vertebra, creating a wedge shape. Multiple fractures can lead to kyphosis.
Causes and risk factors in the elderly
Osteoporosis is the primary cause of most spine fractures in the elderly, with prevalence increasing with age. The resulting brittle bones are prone to collapse under minimal stress. Risk factors include:
- Age and Gender: Bone mass decreases with age, accelerating in postmenopausal women due to lower estrogen levels. Men are also at risk, with prevalence increasing with age.
- Sedentary Lifestyle: Lack of weight-bearing exercise contributes to bone loss.
- Nutritional Deficiencies: Low calcium and vitamin D intake weakens bones.
- Falls: Falls are a major cause of fractures in older adults, compounded by balance issues and reduced mobility.
- Medical Conditions and Medications: Certain illnesses and long-term use of medications like corticosteroids can weaken bones.
Symptoms and long-term effects
Many VCFs, especially gradual ones, may have no symptoms. However, when symptoms occur, they can be severe, including sudden back pain that worsens with standing and improves with lying down. Other effects include:
- Chronic back pain
- Height loss and kyphosis
- Reduced mobility
- Neurological symptoms if nerves are compressed
- Impaired lung function and abdominal discomfort in severe cases
- Increased risk of further fractures
Treatment approaches
Treatment for VCFs in the elderly depends on fracture severity and overall health, ranging from conservative care to surgery.
Comparison of Conservative vs. Surgical Treatment for VCFs
| Treatment Type | Description | Advantages | Disadvantages |
|---|---|---|---|
| Conservative | Bed rest, pain medication, bracing, and physical therapy. | Non-invasive, effective for stable fractures, lower complications. | Can lead to bone loss and muscle weakening; less effective for severe pain; does not correct deformity. |
| Surgical (Kyphoplasty) | Uses a balloon to restore vertebral height before injecting bone cement. | Rapid pain relief, can restore some height, low complication rate. | Invasive; risk of complications like cement leakage, nerve injury, and infection. |
Conclusion
Vertebral compression fractures are the most common spinal fractures in the elderly, primarily due to osteoporosis. Treatment options include conservative care and minimally invasive procedures like kyphoplasty. Prevention is key, focusing on managing osteoporosis through diet, exercise, fall prevention, and medications. Early diagnosis and treatment are vital for managing symptoms, preventing more fractures, and maintaining quality of life. For persistent pain, consulting a spine specialist is important.
How to prevent future spinal fractures
- Eat a calcium and vitamin D rich diet.
- Exercise regularly with weight-bearing activities.
- Prevent falls by removing hazards and installing safety aids.
- Avoid smoking and excessive alcohol.
- Discuss osteoporosis screening and medication with your doctor.
Potential Complications of Vertebral Fractures
- Kyphotic Deformity: Collapsed vertebrae can cause a forward spinal curve.
- Increased Risk of Future Fractures: A previous VCF significantly increases the risk of more fractures.
- Chronic Pain and Disability: Persistent pain, reduced mobility, and loss of independence can occur.
- Neurological Problems: Severe fractures can compress the spinal cord or nerves, causing numbness or weakness.
- Increased Mortality: Studies show a higher mortality rate in older adults with VCFs.
Note: If conservative treatments don't provide enough pain relief, a consultation with a spine specialist or interventional pain specialist may be necessary.
