Vertebral Compression Fracture Management and Prevention

Compression fractures (CFs) of the spinal vertebrae can occur in two main varieties: acute and chronic. Acute CFs can occur at any age and can be quite serious, especially if the bony fragments displace into the spinal canal where the spinal cord in located. These most often represent unstable fractures and must be evaluated immediately to ensure that neurological loss is minimized or avoided. But what about the more common chronic type of compression fracture?

Studies show that our bones are most dense when we are about 30 years old. As we enter middle and older age, the bones can weaken, which is a state called osteopenia. The weakened vertebrae can accumulate small cracks, which can compromise their integrity, resulting in a chronic spinal compression fracture. A December 2020 study concluded that surgery is typically only advised when the fracture is unstable or there is neurological loss, a severe collapse, or intense pain—which may only occur in roughly 15-35% of chronic compression fracture cases.

For the majority of chronic spinal compression fracture patients, a multi-modal team approach to care is advised. A 2018 systematic review of published research on the management of spinal compression fracture recommends an initial non-invasive treatment approach that includes rest, analgesics, orthoses (braces), and early mobilization—a therapy performed by doctors of chiropractic. Once the acute pain subsides, specific exercises should be incorporated into the treatment plan—something chiropractors are trained to provide instruction for.

However, most would like to prevent this condition in the first place, and there are steps that can be taken to reduce ones’ risk. According to Harvard Health and WebMD, the following steps can help maintain healthy, strong bones: consume adequate amounts of vitamin D and calcium (supplements and diet rich in dairy, spinach, broccoli, dried beans, salmon, etc.); avoid carbonated beverages; don’t smoke; don’t drink excessive amounts of alcohol; avoid the prolonged use of medications that can weaken bones, if possible (talk to your medical doctor); and perform weight bearing aerobic and strength training exercises. A bone density scan—the most common being a DEXA-scan—is also recommended, especially for postmenopausal women, adults over 65 years of age, middle-aged adults with a history of fracture, and individuals with a family history of osteoporosis.

Author
Dr. James Sheehan Dr. James Sheehan is an expert in the treatment of neck and back pain.

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