Compression fractures: types, causes and treatment methods

Compression fractures are a type of fracture that occurs when a bone is subjected to pressure that causes it to break. This pressure leads to the compression of the bone, resulting in a change in its shape and size. These fractures are among the most common types of injuries, especially in accidents involving severe pressure, such as falls from heights or traffic accidents. In this medical guide, we will discuss the definition of compression fractures, their types, causes, and symptoms.

What is a Vertebral Compression Fracture (VCF)?

A vertebral compression fracture (VCF) is a specific type of spinal fracture that occurs when one of the vertebrae is subjected to extreme pressure, causing it to break or deform.

What is a Compression Fracture?

A compression fracture happens when a bone experiences excessive pressure beyond its capacity, leading to its collapse or breakage.

Which Bones Are Susceptible to Compression Fractures?

The most common bones affected by compression fractures are the vertebrae of the spine, particularly the lumbar, thoracic, and cervical vertebrae. Long bones, such as the femur, can also be affected.

What Causes Compression Fractures?

The primary causes include osteoporosis, trauma from falls or accidents, and certain medical conditions that weaken bones.

How Is a Compression Fracture Diagnosed?

Diagnosis involves a medical examination, along with imaging techniques such as X-rays, MRI, and CT scans.

What Are the Treatment Options for a Compression Fracture?

Treatment may include medications to strengthen bones, surgical procedures to stabilize the affected vertebrae, and physical therapy to restore mobility and strength.

How Can Compression Fractures Be Prevented?

Prevention involves maintaining bone health through proper nutrition, regular exercise, and avoiding habits that may weaken bones or increase fracture risk.

Types of Compression Fractures

Vertebral Compression Fractures (VCFs)
These fractures occur in the vertebrae of the spine and are the most common type of compression fractures. They can result from falls from a height or continuous pressure on the spine, especially in people with osteoporosis. This type of fracture can cause the vertebra to change shape due to compression.

Compression Fractures in Long Bones
These fractures affect long bones such as the femur or tibia, though they are less common than vertebral fractures. They usually occur due to accidents, such as car crashes or severe trauma, leading to bone compression and breakage.

Pelvic Compression Fractures
These occur when the pelvis is subjected to extreme pressure, often resulting from car accidents, severe falls, or injuries that impact the pelvic region.

Compression Fractures in the Shoulder (Clavicle Fractures)
The clavicle (collarbone) can break due to direct pressure or strong impact, often in sports injuries or falls onto the shoulder.

Compression Fractures in Flat Bones
These fractures occur in flat bones, such as the pelvis or skull, due to severe trauma. They can be serious and may require medical or surgical intervention depending on the severity of the injury.

Compression Fractures in the Elderly
Older adults with osteoporosis are at a higher risk of compression fractures, even without strong pressure, as their bones are weak and can fracture with minimal effort.

Compression Fractures Due to Medical Conditions
Certain diseases, such as cancer or bone infections, can weaken bones, making them prone to fractures even during routine activities.

Compression Fractures from Overloading
These occur when the spine or bones are subjected to excessive pressure, such as in weightlifting or physically demanding activities.

Compression Fractures from Surgical Procedures
In some cases, spinal surgeries can lead to compression fractures as a postoperative complication, weakening the affected bone.

Compression Fractures from Severe Accidents or Falls from Heights
These result from high-impact accidents, such as aviation crashes or violent incidents that exert extreme pressure on the bones.

Chronic Compression Fractures
These develop due to prolonged pressure on bones over time, often seen in people with poor posture or those who perform repetitive movements that strain the bones.

Rare Compression Fractures
These occur in unusual locations, such as facial bones or small bones, often resulting from strong injuries or specific conditions that affect bone health.

Causes of Vertebral Compression Fracture

The most common cause of vertebral compression fractures is osteoporosis, which occurs when bones lose density and become weak, mainly affecting the elderly. However, other factors can also lead to these fractures, such as:

Trauma or Impact on the Back
Severe pressure or strong impact on the spine, such as in car accidents or falls from heights, can cause vertebral fractures.
Spinal Tumors
In rare cases, tumors in the spinal cord that spread to the vertebrae can weaken them, leading to fractures.
Genetic Bone Disorders
Conditions like Osteogenesis Imperfecta, a genetic disease that causes extremely weak bones, can lead to vertebral fractures even with minimal stress.
Bone Infections (Osteomyelitis)
Bacterial or viral infections in bones can damage bone tissue, making it fragile and more prone to fractures.

Symptoms of Vertebral Compression Fracture

Compression fractures in the spine occur when vertebrae collapse or develop cracks due to intense pressure, leading to gradual pain that may become chronic over time. These fractures indicate that the vertebrae can no longer support the spine’s weight. Symptoms include:

Severe Pain in the Affected Area
Pain is the most common symptom, varying from sharp to mild, worsening with movement or pressure on the affected area. Daily activities like walking or prolonged sitting may intensify the pain.
Difficulty Moving
The injured person may struggle with movement due to pain or swelling around the affected vertebrae. Sitting or standing upright can also become difficult.
Bone Deformity
In some cases, the fractured vertebra may change shape. If the fracture is severe, it can lead to spinal curvature or reduced height.
Swelling and Bruising
Compression fractures may cause swelling due to tissue damage. Internal bleeding might also result in bruising around the injury.
Numbness or Tingling
If the fracture compresses nerves, the patient might experience numbness or tingling in areas connected to the affected nerve. Severe nerve compression can lead to loss of sensation in the limbs.
Breathing Difficulty or Chest Pain
Fractures in the thoracic vertebrae may cause chest pain or difficulty breathing due to pressure on the lungs or nerves.
Dizziness and Nausea
Some patients experience dizziness or nausea due to severe pain or nerve pressure affecting balance.
Neurological Issues (If the Fracture Affects Nerves)
Severe fractures pressing on nerves can cause muscle weakness, mobility issues, or even loss of bladder and bowel control in extreme cases.
Pain Worsens with Physical Activity
Activities requiring muscle engagement near the fractured vertebra, such as walking or lifting objects, can intensify the pain.
Spinal Curvature (Kyphosis)
If vertebrae collapse, the spine may curve forward, causing a hunched posture known as kyphosis.
Pain Spreading to Other Areas
A spinal fracture can cause radiating pain in the arms or legs due to nerve compression.
Inability to Stand or Walk
Severe fractures, particularly in the lumbar spine or pelvis, may prevent the patient from standing or walking due to extreme pain or nerve damage.
Fever (Rare Cases)
If an infection occurs post-injury or after surgery, fever may develop due to inflammation in the affected area.
General Fatigue and Weakness
Chronic pain or altered movement patterns after injury can lead to persistent fatigue.
Loss of Height
Spinal fractures can cause vertebrae to collapse, gradually reducing height over time.
Stomach Pain
A vertebral fracture may compress the digestive system, causing loss of appetite, constipation, or weight loss.
Hip Pain
If spinal shortening occurs due to compression fractures, the ribcage may press against the pelvis, leading to hip pain.
Breathing Difficulty
Fractures in the upper spine may affect lung function, making breathing more challenging.

Diagnosis of Vertebral Compression Fracture

The doctor examines the patient to check for spinal curvature or kyphosis (hunchback). To confirm the fracture, the doctor may request several tests, including:

CT Scan (Computed Tomography): Provides detailed imaging of bones to accurately diagnose fractures.
MRI (Magnetic Resonance Imaging): Detects soft tissue damage around the vertebrae and identifies nerve compression.
X-ray: Shows fractures or structural changes in the spine.
Bone Density Test: Determines if osteoporosis is present, a major cause of compression fractures.

Most of these tests (except the bone density test) help diagnose compression fractures. If the cause is a tumor or injury, imaging can reveal it, and the doctor may also check for bruises or external trauma signs.

Treatment of Vertebral Compression Fracture

Once diagnosed, treatment usually starts with rest and pain-relief medications. However, medication alone isn’t enough, as it doesn’t prevent future fractures or spinal deformities. Other treatments include:

Braces or Medical Supports
- Help stabilize the spine and reduce pressure on the affected vertebra.
- Relieve pain and prevent worsening of the condition.
Vertebroplasty
- A medical cement-like material is injected into the fractured vertebra to stabilize it and reduce pain.
- This procedure treats the fracture but doesn’t correct spinal deformities.
Kyphoplasty (Spinal Realignment)
- A balloon is inserted into the collapsed vertebra to restore its height.
- Afterward, the doctor injects bone cement to keep it in place.
- This method helps correct deformities caused by the fracture.
Treating the Underlying Cause
- Osteoporosis treatment is essential to prevent future fractures.
- Without addressing the root cause, new fractures may develop in other vertebrae.
Calcium & Vitamin D Supplements
- Calcium-rich foods: Milk, cheese, yogurt, sardines, almonds.
- Vitamin D sources: Orange juice, eggs, and fatty fish.
- Supplements may be prescribed by a doctor if needed.
Medications to Strengthen Bones
- Certain drugs slow bone loss and promote new bone formation.
- Some cases require hormonal injections to strengthen bones and reduce fragility.
Tumor Treatment (If the Cause is Cancer)
- A biopsy helps determine the tumor type and required treatment.
- Treatment may involve surgery or radiation therapy based on the tumor’s size and location.

Surgical & Non-Surgical Treatments for Compression Fractures

1. Vertebroplasty

Minimally invasive procedure to relieve fracture pain.
Steps:
1. The doctor inserts a thin needle into the fractured vertebra using X-ray guidance.
2. A cement-like substance is injected to stabilize the bone.
3. The material hardens within 10 minutes, fixing the fracture.
4. The patient can leave the hospital the same day or stay overnight, depending on their condition.

2. Kyphoplasty (Hump Correction)

Helps restore spinal shape and reduce pain.
Steps:
1. A thin tube is inserted through a small incision in the back.
2. A small balloon is guided to the fractured vertebra.
3. The balloon is inflated to create space and restore height.
4. The doctor removes the balloon and injects bone cement into the cavity.
5. The material hardens within 10 minutes, stabilizing the vertebra.

3. Spinal Fusion Surgery

This surgical procedure fuses two or more vertebrae together to prevent movement.
Steps:
1. Small metal screws are inserted into the vertebrae using a thin tube.
2. Metal plates are placed in the back of the spine for stability.
3. Bone grafts are added to help the vertebrae fuse naturally.

Recovery Time for Spinal Fractures

Healing takes 2 to 3 months in most cases.
Some patients experience gradual pain relief, while others may continue to feel chronic pain even after healing.
In many cases, fractures occur without noticeable symptoms, but severe cases require ongoing medical monitoring.

Painkillers for Vertebral Compression Fractures

1. Pain Relievers

A. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

These medications help relieve pain and reduce inflammation caused by the fracture. Common examples include:

Ibuprofen
Naproxen

They are effective for mild to moderate pain and help reduce swelling around the affected vertebra.

B. Opioid Painkillers

For severe and chronic pain, doctors may prescribe opioid pain relievers such as:

Morphine
Hydromorphone

These medications are used for short periods due to the risk of addiction with prolonged use.

2. Anti-Inflammatory Medications

Used to reduce swelling around the injured vertebra.
Corticosteroids (e.g., cortisone) may be prescribed in severe cases.
Caution: Long-term corticosteroid use can weaken bones and worsen the condition.

3. Medications That Promote Bone Healing

A. Calcium & Vitamin D Supplements

Essential for patients with osteoporosis or weakened bones:

Calcium: Strengthens bones.
Vitamin D: Enhances calcium absorption.

B. Bone-Strengthening Medications (Bisphosphonates)

Used in osteoporosis to prevent bone deterioration and accelerate healing, including:

Zoledronate (Zoledronic Acid)
Risedronate

These medications reduce the risk of future fractures.

4. Steroids

Recommended for severe injuries (e.g., from accidents or sports).
Used short-term to avoid long-term complications.

5. Muscle Relaxants

To relieve muscle spasms caused by the fracture, doctors may prescribe:

Cyclobenzaprine
Methocarbamol

These medications reduce muscle tension around the affected vertebra.

6. Antibiotics

Prescribed if infection is present, especially after surgery.
Used if the fracture is accompanied by open wounds or abscesses.

7. Medications for Nerve Pain

If the fracture compresses nerves, causing symptoms like tingling or burning pain, doctors may recommend:

Gabapentin
Amitriptyline

These drugs help relieve nerve pain and associated symptoms.

8. Anxiety & Depression Medications

Chronic pain from vertebral fractures can lead to anxiety or depression. Doctors may prescribe:

Citalopram
Fluoxetine (Prozac)

These medications improve mood and reduce psychological stress related to persistent pain.

9. Chemotherapy (For Cancer-Related Fractures)

If the fracture is caused by cancerous tumors, treatment may include:

Chemotherapy
Immunotherapy

These therapies target cancer cells to prevent further damage to the bones.

1. Exercises to Improve Flexibility (Stretching Exercises)

A. Spinal Stretching Exercises

Goal: Reduce tension in the back and improve flexibility.
How to Perform:
1. Stand straight with your hands by your sides.
2. Slowly bend forward from your waist, keeping your legs straight.
3. Try to reach your feet or ankles without applying excessive pressure.
4. Hold this position for 15-20 seconds, then return to the normal position.
Repetition: Repeat the exercise 3 times, being cautious if there is any pain.

B. Leg Muscle Stretching Exercises

Goal: Improve the flexibility of leg and ankle muscles.
How to Perform:
1. Stand straight and place one leg against a wall or on an elevated surface.
2. Slowly lean forward while keeping your leg on the elevated surface.
3. This exercise stretches the back muscles of the leg.
Repetition: Hold the position for 20 seconds for each leg and repeat 3 times.

2. Muscle Strengthening Exercises

A. Back Muscle Strengthening Exercise

Goal: Strengthen the muscles that support the spine.
How to Perform:
1. Lie on your stomach with your knees slightly bent.
2. Slowly lift your upper body (chest and head) using your back muscles.
3. Avoid using your hands or making sudden movements.
Repetition: Start with 5-10 repetitions and gradually increase the count.

B. Abdominal Muscle Strengthening Exercise

Goal: Support the spine and improve balance.
How to Perform:
1. Lie on your back with your knees bent.
2. Place your hands behind your head and slowly lift your upper body.
3. Hold the position for a moment, then return to the normal position.
Repetition: Start with 10 repetitions and gradually increase the count.

3. Balance Improvement Exercises

A. Single-Leg Balance Exercise

Goal: Improve balance and strengthen leg muscles.
How to Perform:
1. Stand straight and try to lift one leg off the ground.
2. Maintain balance for a few seconds, then switch to the other leg.
3. If the exercise is difficult, use a chair or wall for support.
Repetition: 3 sets × 10 repetitions for each leg.

B. Balance Using a Stability Ball

Goal: Improve balance and strengthen the back and legs.
How to Perform:
1. Use a stability ball (like a BOSU ball or Swiss ball).
2. Try to stand on it carefully and hold for 10-15 seconds.
Repetition: Repeat the exercise 3-5 times based on your ability.

4. Joint Mobility Exercises

A. Spinal Mobility Exercises

Goal: Improve back movement and reduce stiffness.
How to Perform:
1. Move your neck forward and backward, then left and right, slowly.
2. Rotate your shoulders in a circular motion to relieve stiffness.
Repetition: 5-10 times for each movement.

B. Leg Extension Exercises

Goal: Improve joint movement and strengthen surrounding muscles.
How to Perform:
1. Sit on a chair and slowly extend one leg forward.
2. Return to the normal position and repeat for the other leg.
Repetition: 3 sets × 10 times for each leg.

5. Deep Breathing Exercises

Goal: Reduce stress and improve blood circulation.
How to Perform:
1. Lie down in a comfortable position and take a deep breath through your nose.
2. Exhale slowly through your mouth.
3. You can add progressive muscle relaxation to this exercise.
Repetition: Repeat the exercise for a few minutes daily.

6. Exercises to Reduce Pressure on Bones

A. Hanging Exercises

Goal: Reduce pressure on the spine.
How to Perform:
1. If you have a hanging bar (like a doorway pull-up bar or stretching device), use it to lift your body slowly.
2. Maintain the hanging position for 5-10 minutes daily.

Note:
All these exercises should be performed carefully and without excessive strain. If you experience any unusual pain, stop the exercise and consult a doctor.

Natural Remedies for Bone Healing

1. Ginger

Benefits: A natural anti-inflammatory that helps reduce pain and swelling while speeding up bone healing.
How to Use:
- Drink ginger tea or add fresh ginger to meals.
- You can also massage the affected area with diluted ginger oil.
Dosage: 1 cup of ginger tea 2-3 times a day.

2. Turmeric

Benefits: Contains "curcumin," a powerful antioxidant and anti-inflammatory that promotes faster bone healing.
How to Use:
- Add it to food or drink turmeric tea (boil ½ teaspoon in a cup of water).
- Available in supplement form as well.
Dosage: 1-2 teaspoons per day.

3. Arnica

Benefits: A powerful herb that reduces pain, swelling, and bruising caused by fractures.
How to Use:
- Apply Arnica cream or gel topically to the affected area 2-3 times daily.
Warning: Do not use on open wounds or cracked skin.

4. Horsetail Herb

Benefits: Rich in calcium and silica, which help strengthen bones and speed up healing.
How to Use:
- Drink horsetail tea or take supplements.
Dosage: 1-2 cups daily.

5. Chamomile ☕

Benefits: A natural relaxant that helps reduce stress and pain and has anti-inflammatory effects.
How to Use:
- Drink chamomile tea or apply a chamomile-infused compress to the affected area.
Dosage: 1-2 cups daily.

6. Green Tea

Benefits: Rich in antioxidants that help reduce inflammation and accelerate bone healing.
How to Use:
- Drink green tea daily or apply it to the affected area.
Dosage: 2-3 cups daily.

7. Lavender

Benefits: A natural pain reliever that promotes relaxation and improves sleep, which may be affected by fracture pain.
How to Use:
- Massage the affected area with diluted lavender oil or add a few drops to bath water.
Dosage: 1-2 times daily.

The specialist who treats compression fractures and issues related to bones and the spine is:

Orthopedic Doctor – Specializes in diagnosing and treating bone and spine problems.
Spine Surgeon – If the condition requires surgical intervention.
Physiotherapist & Rehabilitation Specialist – Helps with exercises and physical therapy after a fracture.