Vertebral Compression Fracture

Also known as: Spinal compression fracture, Vertebral body compression fracture, Vertebral collapse fracture, Wedge compression fracture, Vertebral wedge fracture, Osteoporotic vertebral fracture, VCF (vertebral compression fracture)

Last updated: December 18, 2024

A vertebral compression fracture is a collapse of a spinal bone (vertebral body), most often in the mid or lower back, occurring when bone strength is reduced or forces exceed the bone’s capacity. It often compresses the front of the vertebra, creating a wedge shape that can contribute to spinal curvature. Symptoms can include back pain and midline tenderness, with wide variation in severity. Pain may improve over weeks to months.

Key Facts

•A vertebral compression fracture involve collapse of a vertebral body, most in the thoracic or lumbar spine, and occurs when bone strength is reduced or when external forces exceed the vertebra’s load-bearing capacity
•Acute or subacute back pain that worsens with standing, walking, coughing, or position changes and improve with lying down
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

A vertebral compression fracture may involve collapse of a vertebral body, most often in the thoracic or lumbar spine, and can occur when bone strength is reduced or when external forces exceed the vertebra’s load-bearing capacity. The fracture pattern typically reflects axial loading that compresses the anterior portion of the vertebral body, which can create a wedge-shaped deformity and contribute to spinal kyphosis. Osteoporosis can commonly underlie these fractures, although trauma and malignancy-related bone weakening can also contribute. Pain and functional limitation can vary widely, and some fractures may be minimally symptomatic while still affecting spinal alignment and biomechanics.

Affected Anatomy

This condition affects several structures in and around the joint:

•Vertebral body (anterior and middle columns, including superior and inferior endplates)
•Trabecular (cancellous) bone within the vertebral body
•Intervertebral disc adjacent to the fractured vertebra
•Thoracolumbar junction (T12–L2 region) commonly involved in compression injuries
•Posterior vertebral wall (retropulsion risk in burst-type patterns)
•Spinal canal and thecal sac (potential compromise when fracture fragments encroach)
•Spinal nerve roots exiting at the affected level (possible irritation with deformity or canal narrowing)
•Paraspinal muscles and posterior ligamentous complex (secondary strain and stability considerations)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Acute or subacute back pain that may worsen with standing, walking, coughing, or position changes and can improve with lying down
•Localized midline spinal tenderness over the affected vertebra that can be elicited on palpation or percussion
•Pain that can radiate around the trunk in a band-like pattern, particularly with thoracic level involvement
•Height loss that may develop over time, sometimes associated with multiple compression fractures
•Progressive kyphosis or stooped posture that can contribute to fatigue and altered gait mechanics
•Reduced mobility and functional limitation that can include difficulty bending, lifting, or prolonged sitting/standing
•Neurologic symptoms that may occur when there is canal compromise, including numbness, tingling, weakness, or changes in balance
•Respiratory discomfort or reduced exercise tolerance that can occur with severe thoracic kyphosis affecting chest wall mechanics

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Osteoporosis-related fragility fracture in which reduced bone mineral density and microarchitectural deterioration can allow vertebral collapse with low-energy stress
•Traumatic axial loading from falls, motor vehicle collisions, or sports injuries that can compress the vertebral body and sometimes create burst-type patterns
•Pathologic fracture due to malignancy (such as metastatic disease or multiple myeloma) in which tumor infiltration can weaken vertebral trabecular bone
•Long-term glucocorticoid exposure that can contribute to secondary osteoporosis and increased fragility fracture risk
•Infection-related vertebral weakening (such as osteomyelitis) that can reduce structural integrity and predispose to collapse
•Metabolic bone disorders (for example, osteomalacia) that can reduce bone strength and increases susceptibility to compression injury

Risk Factors

•Older age, which can be associated with lower bone density and higher prevalence of vertebral fragility fractures
•Postmenopausal status, which can contribute to accelerated bone loss related to reduced estrogen levels
•Prior fragility fracture history, which can indicate higher likelihood of additional vertebral fractures
•Low body weight or low body mass index, which can correlate with reduced bone mass and fracture risk
•Chronic glucocorticoid therapy, which can contribute to bone loss and impaired bone quality
•Smoking, which can be associated with reduced bone density and impaired bone remodeling
•Excess alcohol use, which can contribute to falls risk and reduced bone health
•Cancer with bone metastases or plasma cell disorders, which can weaken vertebrae and increases pathologic fracture risk

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and symptom characterization, which can include onset after minor strain or trauma, pain pattern, functional impact, and screening for osteoporosis or malignancy risk factors
•Physical examination that can include inspection for kyphosis or height loss, palpation for focal tenderness, assessment of gait and mobility, and a focused neurologic exam for strength, sensation, and reflex changes
•Spine radiographs (X-rays) that can identify vertebral height loss, wedge deformity, endplate irregularity, and alignment changes; serial imaging can help characterize progression
•Magnetic resonance imaging (MRI) that can help distinguish acute/subacute fractures (often with marrow edema) from chronic fractures and can evaluate spinal canal, nerve roots, and potential malignancy or infection features
•Computed tomography (CT) that can better define fracture morphology, posterior wall involvement, and retropulsed fragments, particularly when surgical planning or canal compromise assessment is needed
•Bone mineral density assessment (DXA scan) that can evaluate osteoporosis and fracture risk context, especially when a low-energy fracture pattern is present
•Laboratory evaluation when secondary causes are suspected, which can include tests that may assess calcium/vitamin D status, thyroid/parathyroid function, inflammatory markers, or malignancy screening depending on clinical context

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest, which can reduce pain-provoking spinal loading during the acute phase while maintaining safe mobility as tolerated
•Spinal bracing (thoracolumbosacral orthosis in selected cases), which can limit flexion, support posture, and potentially reduce pain during healing in some patients
•Osteoporosis evaluation and pharmacologic therapy when indicated, which can include antiresorptive or anabolic agents to reduce future fracture risk and support bone health in appropriate patients
•Fall risk assessment and prevention strategies, which can include home safety evaluation, vision review, and balance-focused interventions to reduce recurrent injury risk
•Vertebral augmentation procedures (vertebroplasty or kyphoplasty) in selected patients, which can be considered for persistent severe pain with imaging-confirmed acute fracture when conservative measures provide limited relief; evidence and selection criteria can vary
•Management of underlying causes such as malignancy or infection, which can include oncology-directed therapies or antimicrobial regimens as appropriate to the etiology and overall clinical picture

Physical Therapy and Exercise

•Physical therapy and supervised rehabilitation, which can focus on posture, core and paraspinal strengthening, hip extensor strengthening, balance training, and safe movement mechanics

Medications

•Pain management approaches that can include non-opioid analgesics and other clinician-directed strategies; medication selection can vary based on comorbidities and risk profile

Surgery

•Surgical stabilization and decompression in selected cases, which can be considered when there is significant instability, progressive deformity, or neurologic compromise due to canal encroachment

Prognosis and Recovery

The course of this condition varies between individuals:

•Pain from an uncomplicated osteoporotic compression fracture can often improve over weeks to months, although symptom duration can vary based on fracture acuity, number of levels involved, and baseline health.
•Some individuals can develop chronic pain or functional limitation, particularly when multiple fractures contribute to progressive kyphosis and altered spinal biomechanics.
•Risk of additional vertebral fractures can be higher after an initial compression fracture, especially when osteoporosis remains untreated or secondary causes persist.
•Neurologic outcomes are typically favorable when there is no canal compromise, while fractures with retropulsion or instability can carry higher risk of neurologic symptoms and may require more intensive interventions.
•Quality of life impact can depend on pain control, mobility, posture changes, and comorbidities; rehabilitation and bone health management can influence longer-term function.

Lumbar Spinal Fusion(Procedure)
Osteoporosis(Condition)
Lumbar Laminectomy(Procedure)

Frequently Asked Questions

Common symptoms include: Acute or subacute back pain that may worsen with standing, walking, coughing, or position changes and can improve with lying down; Localized midline spinal tenderness over the affected vertebra that can be elicited on palpation or percussion; Pain that can radiate around the trunk in a band-like pattern, particularly with thoracic level involvement; Height loss that may develop over time, sometimes associated with multiple compression fractures; Progressive kyphosis or stooped posture that can contribute to fatigue and altered gait mechanics.

Diagnosis typically involves: Clinical history and symptom characterization, which can include onset after minor strain or trauma, pain pattern, functional impact, and screening for osteoporosis or malignancy risk factors; Physical examination that can include inspection for kyphosis or height loss, palpation for focal tenderness, assessment of gait and mobility, and a focused neurologic exam for strength, sensation, and reflex changes; Spine radiographs (X-rays) that can identify vertebral height loss, wedge deformity, endplate irregularity, and alignment changes; serial imaging can help characterize progression; Magnetic resonance imaging (MRI) that can help distinguish acute/subacute fractures (often with marrow edema) from chronic fractures and can evaluate spinal canal, nerve roots, and potential malignancy or infection features.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest, which can reduce pain-provoking spinal loading during the acute phase while maintaining safe mobility as tolerated; Pain management approaches that can include non-opioid analgesics and other clinician-directed strategies; medication selection can vary based on comorbidities and risk profile; Spinal bracing (thoracolumbosacral orthosis in selected cases), which can limit flexion, support posture, and potentially reduce pain during healing in some patients; Physical therapy and supervised rehabilitation, which can focus on posture, core and paraspinal strengthening, hip extensor strengthening, balance training, and safe movement mechanics; Osteoporosis evaluation and pharmacologic therapy when indicated, which can include antiresorptive or anabolic agents to reduce future fracture risk and support bone health in appropriate patients.