A compression fracture is a break in a bone of the spine that occurs when little or no trauma causes a compression of the vertebral body. It typically happens in the thoracic or lumbar spine.
How does a Compression Fracture happen?
The vertebral body is the part of the individual spine bone or vertebrae that is in the front of the spine. This part of the bone is shaped like a cylinder or a can. Similar to a soda can, it can get squished. This is an uncommon type of fracture in young healthy people but as we age our bone becomes less dense and we can develop a condition known as osteoporosis. Bone that is less dense is weaker and more likely to fracture. Other less common causes of decreased bone density include tumors of the bone, chronic steroid treatment and several chronic medical conditions.
Compression Fractures and Osteoporosis
No discussion of compression fractures is complete without a description of osteoporosis. Osteoporosis is a condition where the bone becomes less dense and thus weaker. For all people, their bone density and strength peaks in their 20s and tends to decrease from there. Women have a lower peak bone density and also have a period of rapid decrease in bone density around menopause, so they are typically affected by osteoporosis at a younger age. Men also get osteoporosis, but on average, it occurs when they are older. Since women live longer than men, and men don’t get osteoporosis until they are older, the prevalence of osteoporosis is higher in women. Osteoporosis is also more common in people with pale skin and runs if families.
Osteoporosis itself is not painful. The problem is that osteoporosis leads to weak bones and a higher fracture risk. It is the fractures that are painful.
The onset of osteoporosis can be delayed by a combination of good nutrition and weight bearing exercise. Good nutrition includes getting enough calcium and vitamin D. Unfortunately just taking calcium and Vitamin D supplements does not seem to work as well as getting these nutrients in food. In addition certain common medications, including medicines that block stomach acid production, can limit the ability of the intestine to absorb these essential nutrients. To get vitamin D naturally also requires exposure to sunlight. Exercise is also essential to build and maintain strong bone. The old adage “use it or lose it” definitely applies to bone strength. This exercise needs to strain the bones in order to stimulate the body to strengthen them, just like you have to strain muscle to build it up. For this reason, some types of exercise like swimming and cycling, that are very good for cardio vascular fitness, are not as likely to help with bone density. Basically, to delay the onset of osteoporosis, eat enough calcium and get outdoors for some sun and weight bearing exercise!
How do you avoid fractures?
There is more to avoiding a compression fracture or other fractures related to weak bone, together know as fragility fractures, than just preventing osteoporosis. The other key is to avoid the trauma that can cause a fracture. The most common cause of fragility fractures is a fall and most falls occur in the home. Exercise is probably the best way to prevent falls, specifically exercise that requires balance. This can be the same weight bearing exercise that you use to prevent osteoporosis. If a patient has a history of falls, physical therapy can be arranged to teach and guide a fall prevention exercise program. In addition home safety is very important. Keep the floors clear of objects that might trip someone and making sure there are no loose carpets or rugs. Be cautious with small pets that might get underfoot. Use nightlights to illuminate the path to the restroom and other places that you need to walk at night. Lastly, don’t be too proud to use a cane or a walker if it is safer. If you are worried about your home situation it is often possible to have a home safety evaluation arranged.
For patients that have been on chronic steroids, have a history or tumors in the spine, have intestinal issues that may cause malabsorption or other chronic disease that might lead to weak bone, please ask your primary care doctor or the doctor that regularly treats you to get a test of your bone density.
Fracture Prevention & Osteoporosis
If you have been diagnosed with osteoporosis, it is not too late. Good nutrition, exercise and fall prevention can still help. In addition talk to you primary care doctor about medications for osteoporosis. There are many medication options and medications have been shown to decrease the fracture rate. Preventing fractures is key. Over the past few years we have learned more and more about the negative consequences associated with fragility fractures. Patients with fragility fractures such as compression fractures or a hip fracture have a significantly decreased life expectancy that patients that have not had a fracture. Once you have had one fracture your are several times more likely to have a second fracture. Once you have had two fractures you are many times more likely to have a third or more. This leads to a life threatening downward spiral. This is why fracture prevention is so important! So remember the keys to avoiding fractures are:
- Good nutrition
- Weight bearing exercise hopefully with some sun exposure
- Avoiding falls and trauma
- Knowing if you have a medical condition that predisposes you to weak bone
- Getting your bone density checked
- Medical management if your bone is already weak
For more great advice on prevention and treatment of osteoporosis check out the National Osteoporosis Foundation at https://www.nof.org/.
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