Vertebral Compression Fractures from Osteoporosis in the Elderly

Vertebral compression fractures from osteoporosis in the elderly occur when the vertebrae break and collapse due to osteoporosis. The bones of elderly patients with osteoporosis are weaker than those of normal elderly, making even minor falls capable of causing vertebral compression fractures or spine fractures.
The primary cause of vertebral compression fractures is mostly due to osteoporosis, both primary osteoporosis that occurs naturally with aging and secondary osteoporosis resulting from illness or medication use such as kidney failure.
Symptoms of vertebral compression fractures are pain in the area with vertebral compression, commonly found in the mid-back or lower back region, and persistent backache.
The diagnosis of vertebral compression fractures involves X-rays of the spine, performed in the suspected fracture area, MRI (Magnetic Resonance Imaging), for patients with vertebral compression fractures who have persistent chronic pain for several weeks to determine whether the collapsed vertebrae have fused together, and bone mineral density (BMD) testing, to confirm whether the patient has osteoporosis. If osteoporosis is detected, there’s a high risk that the backache results from vertebral compression fractures.
Treatment approaches for vertebral compression fractures from osteoporosis can be divided into three main methods: 1) Non-surgical treatment – Doctors will consider primary treatment with pain relievers, calcium supplements, and osteoporosis medications, along with wearing a back brace to externally support the spine. 2) Bone cement injection – When vertebral compression fractures have been initially treated but the patient continues experiencing chronic pain, doctors will use MRI to check whether the bones have connected. If the fractured vertebrae haven’t healed, doctors will consider treatment with bone cement injection into the unfused vertebrae to promote healing and reduce pain. 3) Surgical treatment – It is only performed when there are indications like the affected bone compresses spinal nerves. This case requires surgery to insert metal hardware for spinal stabilization and decompress the affected nerves.
Treating vertebral compression fractures at kdms Hospital, patients will meet a team of medical experts specialized in bones, joints, and muscles who provide comprehensive care for elderly patients with vertebral compression fractures from osteoporosis. Our rehabilitation and physical therapy team cares for patients with vertebral compression fractures to help them return to normal, happy lives. We provide support before, during, and after treatment with close patient care.

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Vertebral compression fractures from osteoporosis in the elderly

Vertebral compression fractures from osteoporosis in the elderly occur when the vertebrae break and collapse due to osteoporosis. The bones of elderly patients with osteoporosis are weaker than those of normal elderly, making even minor falls or daily activities that create normal impact forces on the back capable of causing vertebral compression fractures or spine fractures.

Causes of vertebral compression fractures

The primary cause of vertebral compression fractures is mostly due to osteoporosis. The causes of osteoporosis can be divided into two main categories:

Primary osteoporosis that occurs naturally with aging, commonly found in elderly men and women.
Secondary osteoporosis resulting from illness or medication use, which is osteoporosis caused by factors other than age, such as certain diseases that cause premature osteoporosis including kidney failure, diseases requiring regular steroid medication, or conditions requiring ovary removal surgery that results in hormone deficiency and osteoporosis.

Generally, our spine maintains its shape because the vertebrae are strong and have normal bone mineral density (BMD). However, the development of osteoporosis makes bone density decrease, making the spine less resistant to impact forces and creating a high risk of vertebral compression fractures.

The criteria for diagnosing osteoporosis can be measured through bone mineral density figures. If a person’s BMD is less than -2.5, that person is considered having osteoporosis with high risk for vertebral compression fractures. However, even though the results of bone mineral density measurements are normal, having vertebral compression fractures after a fall or an accident indicates that the bone strength may not be as good as it seems. This can also be considered a type of osteoporosis.

What are the symptoms of vertebral compression fractures?

Osteoporosis is considered a “silent” disease that shows no symptoms unless an accident or a fall causes bone fractures. Therefore, it’s impossible to know if someone has osteoporosis without bone mineral density testing. However, when osteoporosis patients experience falls or engage in activities that risk vertebral compression, such as bending forward to lift heavy objects or sitting down with excessive impact force, the following symptoms of vertebral compression fractures can be observed:

Pain in the area of vertebral compression

The most common location of vertebral compression is the area that connects the upper back with the lower back, called the “thoracolumbar junction” area. Therefore, patients feel pain in the mid-back or lower back region. Elderly patients who experience minor accidents followed by sudden, acute pain may be suspected of having vertebral compression fractures.

Persistent backache

Normal individuals without vertebral compression fractures typically don’t experience pain when sitting, walking, standing, lying down, or changing positions. However, patients with vertebral compression fractures experience backache with any movement, or even when lying down and turning to change positions.

How are vertebral compression fractures diagnosed?

When elderly patients experiencing minor accidents have severe backache, they must consult a doctor and will be tested for vertebral compression fractures using the following diagnostic approaches:

X-rays of the spine: performed in the suspected fracture area to confirm whether vertebral compression has actually occurred.
MRI (Magnetic Resonance Imaging): for patients with vertebral compression fractures who have persistent chronic pain for several weeks. MRI helps determine whether the collapsed vertebrae have fused together. Also, it reveals whether the vertebral compression fractures are caused by factors other than osteoporosis such as tumors in the spinal area.
Bone Mineral Density (BMD) testing: to confirm whether the patient has osteoporosis. If osteoporosis is detected, there’s a high risk that the backache results from vertebral compression fractures. Bone mineral density testing is also a preventive measure for vertebral compression fractures because having osteoporosis detected leads to effective treatments which also reduce the risk of vertebral compression fractures. The bone mineral density testing procedure takes only 5-10 minutes, performed with X-ray scanning through a DXA Scan machine that sends radiation to the target area. The two common positions used to diagnose osteoporosis are the spine and hip bones. If BMD values are less than -2.5, the patient will be diagnosed having osteoporosis with high risk for vertebral compression fractures.

How are vertebral compression fractures treated?

X-rays of the spine: performed in the suspected fracture area to confirm whether vertebral compression has actually occurred.
MRI (Magnetic Resonance Imaging): for patients with vertebral compression fractures who have persistent chronic pain for several weeks. MRI helps determine whether the collapsed vertebrae have fused together. Also, it reveals whether the vertebral compression fractures are caused by factors other than osteoporosis such as tumors in the spinal area.
Bone Mineral Density (BMD) testing: to confirm whether the patient has osteoporosis. If osteoporosis is detected, there’s a high risk that the backache results from vertebral compression fractures. Bone mineral density testing is also a preventive measure for vertebral compression fractures because having osteoporosis detected leads to effective treatments which also reduce the risk of vertebral compression fractures. The bone mineral density testing procedure takes only 5-10 minutes, performed with X-ray scanning through a DXA Scan machine that sends radiation to the target area. The two common positions used to diagnose osteoporosis are the spine and hip bones. If BMD values are less than -2.5, the patient will be diagnosed having osteoporosis with high risk for vertebral compression fractures.

How are vertebral compression fractures treated?

Treatment approaches for vertebral compression fractures from osteoporosis in the elderly can be divided into three main methods, depending on symptoms and medical judgment:

1. Non-surgical treatment for vertebral compression fractures

Initially, after patients have fallen or experienced accidents causing vertebral compression fractures with backache affecting daily life, doctors will consider primary treatment with pain relievers, calcium supplements, and osteoporosis medications, along with wearing a back brace to externally support the spine. Behavioral modifications are also necessary, avoiding bending, heavy lifting, or activities that risk repeated accidents.

Naturally, fractured vertebrae can heal and reconnect on their own, taking an average of 4-6 weeks for natural healing. However, it’s also possible that they may not reconnect normally, depending on self-care, bone strength, and bone density in each individual patient.

2. Treatment of vertebral compression fractures with bone cement injection

When vertebral compression fractures have been initially treated but the patient continues experiencing chronic pain, doctors will use MRI to check whether the bones have connected. If the fractured vertebrae haven’t healed (non-union), doctors will consider treatment with bone cement injection into the unfused vertebrae to promote healing and reduce pain. Treatment of vertebral compression fractures with bone cement injection is divided into two methods based on each patient’s symptom severity:

1. Bone cement injection using vertebroplasty

Doctors use needles to pierce directly into the vertebrae and inject bone cement into the fractured vertebral area.

2. Bone cement injection using balloon kyphoplasty

This method is used when patients have severely collapsed vertebral compression fractures. Doctors use special equipment to pierce into the collapsed vertebral area, then insert a balloon to expand and push the collapsed vertebrae back to the normal height to reduce the compression. After that, bone cement is injected to make the vertebrae adhere and harden back to normal condition.

Preparation before vertebral compression fracture treatment with bone cement injection

Similar to general surgery, patients must undergo physical health examinations to determine readiness for treatment.

Steps in treating vertebral compression fractures with bone cement injection

Doctors begin by administering anesthesia so patients don’t experience pain during treatment
Use X-ray scanning in the surgery room to help determine the position for bone cement injection
Doctors use special needles specifically for bone cement injection to pierce into the collapsed vertebral area, with puncture holes measured only about 2-3 millimeters
After confirming the right position, doctors proceed to inject bone cement into that vertebrae
Overall treatment time takes approximately 40 minutes to 1 hour, including bone cement hardening period

Self-care after vertebral compression fracture treatment with bone cement injection

Generally, after bone cement injection is completed, patients’ backache immediately decreases. They can also get up, sit, walk, and stand after waking from anesthesia.

Initially after treatment, doctors will require patients wearing a back brace, along with osteoporosis medications to prevent future vertebral compression fractures and maintain bone strength. Meanwhile, behavioral modifications are also necessary to prevent recurrence, such as avoiding bending, heavy lifting, falling, or activities that risk repeated accidents.

Surgical treatment for vertebral compression fractures

Surgical treatment for vertebral compression fractures occurs in rare cases. It is only performed when there are indications like the affected bone compresses spinal nerves. This case requires surgery to insert metal hardware for spinal stabilization and decompress affected nerves.

The procedure for treating vertebral compression fractures with surgery begins with examining the patient’s physical condition to see if the patient is ready for surgery. If ready, the surgeon will give anesthesia, like in bone cement injection treatment, then perform an open incision to insert metal hardware into the spine area. In this step, the surgeon may choose to pierce a hole instead and insert the metal stabilizer into the back area.

After surgery, patients will have to stay at the hospital for recovery and symptom monitoring. When the pain decreases, patients can get up and walk normally. They can go home only if the doctor considers being safe to go and risk-free.

The perks of treating vertebral compression fractures at kdms Hospital

kdms Hospital in Bangkok, Thailand, is a specialized orthopedic and joint hospital that provides comprehensive care for elderly patients with vertebral compression fractures from osteoporosis. We offer readiness and excellence in treatment to create peace of mind for patients and their families through the following services:

Bone mineral density screening and monitoring by specialized osteoporosis doctors to assess osteoporosis risk, which is the best prevention strategy for vertebral compression fractures.
Comprehensive vertebral compression fracture treatment, from non-surgical treatment, medication therapy, and external spinal support devices, to bone cement injection and surgery, which is required due to nerve compression from vertebral compression fractures.
Advanced diagnostic capabilities with MRI imaging to determine whether collapsed vertebrae have healed properly or if vertebral compression fractures are caused by other factors, enabling precise and appropriate treatment planning.
Rehabilitation and physical therapy team that cares for patients with vertebral compression fractures to help them return to normal, happy lives. We provide support before, during, and after treatment with close patient care.

In summary

Osteoporosis is a silent disease that remains undetectable without proper screening, as it produces no pain symptoms as warning signs. Therefore, to reduce risks of vertebral compression fractures from osteoporosis in the elderly as much as possible, bone mineral density testing is crucial and should not be overlooked. This enables early disease detection and effective treatment planning.

Additionally, for the elderly who are unsure whether they have osteoporosis but experience chronic backache that doesn’t resolve, with persistent back pain when getting up, walking, sitting, or changing positions, they should promptly consult a doctor for proper diagnosis to determine the hidden cause and develop appropriate treatment plans.

Therefore, to help ourselves and our beloved elderly family members return to normal, happy lives, if you notice abnormal chronic backache or sudden back pain following minor accidents, don’t ignore these symptoms and consult a doctor as soon as possible.

Q & A

Environmental safety measures: Maintain a safe living environment and reduce the risks of slip and fall or accidents that could lead to vertebral compression fractures. This includes choosing non-slip flooring tiles, ensuring adequate lighting for clear visibility, and organizing belongings neatly to avoid walking obstacles.
Personal health monitoring: Regularly assess your physical condition to ensure strength and minimize risks of accidents that could lead to vertebral compression fractures. Consider factors such as vision problems, clarity of sight, balance stability, and muscle weakness. If your body isn’t strong or has abnormal issues, the risk of causing accidents increases significantly.
Osteoporosis treatment: The elderly should undergo bone mineral density testing. If osteoporosis is detected, treatment should begin immediately to reduce vertebral compression fracture risk. For patients who already have vertebral compression fractures, osteoporosis treatment remains essential to prevent recurrent spine fractures.
Maintain optimal bone and muscle mass: This can be achieved through light exercise such as walking, aerobic dancing, tai chi, and similar activities. Exercise helps strengthen our bone mass and muscles, providing more effective protection against bone compression fractures.

Bone mineral density testing is the only way to determine whether someone has osteoporosis, making it an excellent preventive step for reducing vertebral compression fracture risk from osteoporosis in the elderly. Recommendations are women should begin testing their bone mineral density at the age of 65 and older, while men should start testing from 70 and beyond.

The reason women should take the test earlier than men is because they have higher risks of osteoporosis. After menopause, women’s hormones decrease dramatically, causing rapid bone mass loss. The first three years after menopause represent the period of greatest bone mass reduction. Therefore, women need bone mineral density testing earlier than men and must accumulate sufficient calcium before menopause, combined with regular exercise to build bone mass before it’s depleted during menopause. This helps reduce osteoporosis risk that can easily lead to vertebral compression fractures.

However, osteoporosis can sometimes occur earlier than normal, even not reaching an old age. Examples include patients with kidney failure, those requiring regular steroid medications, or patients who undergo ovary removal causing hormone deficiency. In such cases, there’s risk of developing premature osteoporosis, which can only be detected through bone mineral density testing.

For younger ages, aim for consuming 800 milligrams of calcium daily. As we get older, increase calcium intake to 1,000 milligrams per day. Consume calcium from any source, whether through food such as milk, beans, fish, or through dietary supplements and vitamins.

However, bone mass strength depends not only on calcium and vitamin intake but also significantly on exercise. Without regular physical activity, bone mass and muscle mass will decrease and their strength will be reduced below optimal levels. This can ultimately lead to osteoporosis and a risk of vertebral compression fracture in the future.

An article by Jirachai Pisutbenya, M.D., Experienced Spine Surgeon

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