Diagnosis and Management of Vertebral Compression Fracture


      Vertebral compression fractures are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States. Vertebral compression fractures typically present with abrupt-onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally. Diagnosis is confirmed using plain radiographs, while computed tomography and magnetic resonance imaging may be required to evaluate for a malignant cause or if there are neurological deficits on examination. Magnetic resonance imaging is also the modality of choice to determine if the fracture is acute vs chronic in nature. Patients can be managed with a combination of nonsurgical modalities including medications, bracing, and physical therapy, although when indicated, kyphoplasty or vertebroplasty may be considered to provide symptom relief.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Salari N
        • Ghasemi H
        • Mohammadi L
        • et al.
        The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis.
        J Orthop Surg. 2021; 16: 609
        • Sarafrazi N
        • Wambogo EA
        • Shepherd JA
        Osteoporosis or low bone mass in older adults: United States, 2017-2018.
        National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), 2021 (Available at:) (Accessed March 23, 2022)
        • Ji MX
        • Yu Q
        Primary osteoporosis in postmenopausal women.
        Chronic Dis Transl Med. 2015; 1: 9-13
        • Zhang Q
        • Cai W
        • Wang G
        • Shen X
        Prevalence and contributing factors of osteoporosis in the elderly over 70 years old: an epidemiological study of several community health centers in Shanghai.
        Ann Palliat Med. 2020; 9: 231-238
        • Melton 3rd, LJ
        Epidemiology of osteoporosis: predicting who is at risk.
        Ann N Y Acad Sci. 1990; 592: 295-306
        • Marcucci G
        • Brandi ML
        Rare causes of osteoporosis.
        Clin Cases Miner Bone Metab. 2015; 12: 151-156
        • Wright NC
        • Looker AC
        • Saag KG
        • et al.
        The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine.
        J Bone Miner Res. 2014; 29: 2520-2526
        • Lehouck A
        • Boonen S
        • Decramer M
        • Janssens W
        COPD, bone metabolism, and osteoporosis.
        Chest. 2011; 139: 648-657
        • McCarthy J
        • Davis A
        Diagnosis and management of vertebral compression fractures.
        Am Fam Physician. 2016; 94: 44-50
        • Alexandru D
        • So W
        Evaluation and management of vertebral compression fractures.
        Perm J. 2012; 16: 46-51
        • Wong CC
        • McGirt M
        Vertebral compression fractures: a review of current management and multimodal therapy.
        J Multidiscip Healthc. 2013; 6: 205-214
        • Parreira PCS
        • Maher CG
        • Megale RZ
        • March L
        • Ferreira ML
        An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review.
        Spine J. 2017; 17: 1932-1938
        • Kim HJ
        • Park S
        • Park SH
        • et al.
        Prevalence of frailty in patients with osteoporotic vertebral compression fracture and its association with numbers of fractures.
        Yonsei Med J. 2018; 59: 317-324
        • Mauch JT
        • Carr CM
        • Cloft H
        • Diehn FE
        Review of the imaging features of benign osteoporotic and malignant vertebral compression fractures.
        AJNR Am J Neuroradiol. 2018; 39: 1584-1592
        • Bravo AE
        • Brasuell JE
        • Favre AW
        • Koenig BM
        • Khan AA
        • Beall DP
        Treating vertebral compression fractures: establishing the appropriate diagnosis, preoperative considerations, treatment techniques, postoperative follow-up and general guidelines for the treatment of patients with symptomatic vertebral compression fractures.
        Tech Vasc Interv Radiol. 2020; 23100701
        • Downie A
        • Williams CM
        • Henschke N
        • et al.
        Red flags to screen for malignancy and fracture in patients with low back pain: systematic review.
        BMJ. 2013; 347: f7095
        • Green AD
        • Colón-Emeric CS
        • Bastian L
        • Drake MT
        • Lyles KW
        Does this woman have osteoporosis?.
        JAMA. 2004; 292: 2890-2900
        • Papa JA
        Conservative management of a lumbar compression fracture in an osteoporotic patient: a case report.
        J Can Chiropr Assoc. 2012; 56: 29-39
        • Panda A
        • Das CJ
        • Baruah U
        Imaging of vertebral fractures.
        Indian J Endocrinol Metab. 2014; 18: 295-303
        • Genant HK
        • Wu CY
        • van Kuijk C
        • Nevitt MC
        Vertebral fracture assessment using a semiquantitative technique.
        J Bone Miner Res. 1993; 8: 1137-1148
        • Tanigawa N
        • Komemushi A
        • Kariya S
        • Kojima H
        • Shomura Y
        • Sawada S
        Radiological follow-up of new compression fractures following percutaneous vertebroplasty.
        Cardiovasc Intervent Radiol. 2006; 29: 92-96
        • Knopp-Sihota JA
        • Newburn-Cook CV
        • Homik J
        • Cummings GG
        • Voaklander D
        Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis.
        Osteoporos Int. 2012; 23: 17-38
        • Lyritis GP
        • Mayasis B
        • Tsakalakos N
        • et al.
        The natural history of the osteoporotic vertebral fracture.
        Clin Rheumatol. 1989; 8: 66-69
        • Genev IK
        • Tobin MK
        • Zaidi SP
        • Khan SR
        • Amirouche FML
        • Mehta AI
        Spinal compression fracture management.
        Glob Spine J. 2017; 7: 71-82
        • Franklin GM
        • American Academy of Neurology
        Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology.
        Neurology. 2014; 83: 1277-1284
        • Azria M
        Possible mechanisms of the analgesic action of calcitonin.
        Bone. 2002; 30: 80S-83S
        • Francis RM
        • Anderson FH
        • Torgerson DJ
        A comparison of the effectiveness and cost of treatment for vertebral fractures in women.
        Br J Rheumatol. 1995; 34: 1167-1171
        • Boucher E
        • Rosgen B
        • Lang E
        Efficacy of calcitonin for treating acute pain associated with osteoporotic vertebral compression fracture: an updated systematic review.
        Can J Emerg Med. 2020; 22: 359-367
        • Brunton S
        • Carmichael B
        • Gold D
        • et al.
        Vertebral compression fractures in primary care: recommendations from a consensus panel.
        J Fam Pract. 2005; 54: 781-789
        • Ross AC
        • Manson JE
        • Abrams SA
        • et al.
        The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know.
        J Clin Endocrinol Metab. 2011; 96: 53-58
        • Buckley L
        • Guyatt G
        • Fink HA
        • et al.
        2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis.
        Arthritis Care Res. 2017; 69: 1095-1110
        • Watts NB
        • Adler RA
        • Bilezikian JP
        • et al.
        Osteoporosis in men: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2012; 97: 1802-1822
        • Camacho PM
        • Petak SM
        • Binkley N
        • et al.
        American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2016.
        Endocr Pract. 2016; 22: 1-42
        • Tu KN
        • Lie JD
        • Wan CKV
        • et al.
        Osteoporosis: a review of treatment options.
        P T. 2018; 43: 92-104
        • Masala S
        • Fiori R
        • Massari F
        • Simonetti G
        Kyphoplasty: indications, contraindications and technique.
        Radiol Med (Torino). 2005; 110: 97-105
        • McCall T
        • Cole C
        • Dailey A
        Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events.
        Curr Rev Musculoskelet Med. 2008; 1: 17-23
        • Wang B
        • Zhao CP
        • Song LX
        • Zhu L
        Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review.
        J Orthop Surg Res. 2018; 13: 264
        • Kallmes DF
        • Comstock BA
        • Heagerty PJ
        • et al.
        A randomized trial of vertebroplasty for osteoporotic spinal fractures.
        N Engl J Med. 2009; 361: 569-579
        • Halvachizadeh S
        • Stalder AL
        • Bellut D
        • et al.
        Systematic review and meta-analysis of 3 treatment arms for vertebral compression fractures: a comparison of improvement in pain, adjacent-level fractures, and quality of life between vertebroplasty, kyphoplasty, and nonoperative management.
        JBJS Rev. 2021; 9: e21.00045