Osteoporotic Spine Fractures (Vertebral Compression Fractures)
Osteoporotic vertebral compression fractures are collapse fractures occurring in osteoporotic bone after minimal trauma or spontaneously. They are most common in postmenopausal women and at the thoracolumbar junction, causing sudden back pain and height loss. Most cases heal with conservative treatment.
마지막 업데이트: 2026-06-06
Definition
Osteoporotic vertebral compression fractures (OVCF) are collapse of a vertebral body weakened by osteoporosis under axial load. They are the most common type of osteoporotic fracture and occur especially at the thoracolumbar junction (T12-L1). They can result from minimal trauma such as a light fall, bending or coughing, or even occur spontaneously. Each fracture reduces vertebral height and causes height loss, and one fracture markedly raises the risk of further fractures (the fracture cascade).
Causes and Risk Factors
The underlying cause is osteoporosis: as bone resorption outpaces formation, bone mass falls and the microarchitecture deteriorates, making the trabecular (spongy) bone that forms most of the vertebral body fragile. Non-modifiable risk factors include older age, female sex (postmenopausal estrogen deficiency), genetic/family history of fracture, early menopause and slight body build. Modifiable factors include long-term corticosteroid use, smoking, excess alcohol, calcium/vitamin D deficiency and a sedentary lifestyle. Hyperthyroidism, hyperparathyroidism, rheumatoid arthritis, malabsorption and certain drugs cause secondary osteoporosis.
Symptoms
In an acute fracture the typical finding is sudden, severe back pain, often triggered by a minor event; the pain is localized to the fracture level, worsens with sitting up and turning, and eases when lying down. When multiple fractures accumulate, progressive height loss and forward stooping (kyphosis / dowager's hump) develop, which can reduce breathing capacity and impair balance. Many fractures are silent and found incidentally on imaging. Neurological compression is rare, but a retropulsed fragment may cause leg pain or weakness.
Diagnosis
The first step is plain radiography, which shows vertebral collapse and wedge deformity. MRI distinguishes an acute fracture (bone-marrow edema, increased STIR signal) from an old one and evaluates neurological compression and any suspicion of a pathological (tumor/infection) fracture. CT shows bony structure and any retropulsion of fragments. The degree of osteoporosis is determined by DEXA bone densitometry (T-score); secondary osteoporosis and pathological fracture must be excluded.
Treatment Options
Most cases heal with conservative treatment: short-term pain management (analgesics), early mobilization, bracing in selected cases and physical therapy. For severe pain unresponsive to conservative care, minimally invasive vertebral augmentation may be performed: vertebroplasty (injecting bone cement into the fractured body) or kyphoplasty (first restoring height with a balloon, then injecting cement). Marked neurological compression or instability may require open surgery (decompression with or without instrumentation); cemented/fenestrated screws are preferred in osteoporotic bone. In all patients, the essential treatment is management of the underlying osteoporosis.
Osteoporosis Treatment and Prevention
Treating osteoporosis is the foundation of preventing new fractures. Adequate calcium and vitamin D intake, regular weight-bearing exercise, stopping smoking and excess alcohol, and reducing fall risk are basic measures. Drug therapy uses antiresorptive agents (bisphosphonates, denosumab) and, in high-risk or severe cases, bone-forming agents (such as teriparatide). The choice and duration of medication are determined by the physician based on individual risk assessment.
Prognosis
Most osteoporotic fractures heal within weeks with conservative treatment and the pain settles. However, having a fracture raises the risk of new fractures and of overall mortality in the first year; for this reason, treating osteoporosis and preventing falls are critical. Vertebral augmentation can provide rapid pain relief in appropriately selected patients. Outcomes vary individually with age, bone quality and comorbidities.
참고 문헌
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1208-1215.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- North American Spine Society (NASS) — Coverage Recommendations: Vertebral Augmentation.
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