Condition
Osteoporosis and Compression Fractures
Osteoporosis is loss of bone density that leaves the vertebrae weak enough to collapse, sometimes from nothing more than a cough, a sneeze or lifting a bag of groceries.
- Seen at
- All three offices
- Typical wait
- Within the same week
- Treated with
- 4 procedures
In short
What compression fractures actually is.
Osteoporosis and Compression Fractures
Osteoporosis is loss of bone density that leaves the vertebrae weak enough to collapse, sometimes from nothing more than a cough, a sneeze or lifting a bag of groceries. That collapse is a vertebral compression fracture, and it is one of the more painful things that happens to a spine. Dr. Sheikh does not treat osteoporosis itself. Bone density treatment belongs with your primary care physician, endocrinologist or rheumatologist, and this page is about managing the pain the fractures cause while they handle the bone.
Symptoms
How it shows up.
If several of these sound like your week, it is worth having the source looked at properly.
- Sudden severe pain in the middle or lower back that started during a cough, a sneeze or lifting something light
- Sharp pain moving from lying to sitting, which settles when you lie flat and stay still
- A band of pain that wraps from the spine around the ribs toward the front
- Losing height, or noticing that clothes fit differently through the middle
- A rounding forward of the upper back that has appeared over the last year or two
- Pain when you press on one specific spot along the spine rather than a broad area
- Feeling full quickly or short of breath as the rib cage settles closer to the pelvis
What causes it
- Osteoporosis, which thins the bone until ordinary loads exceed what it can carry
- Age and the drop in estrogen after menopause, which accelerates bone loss
- Long term corticosteroid treatment for asthma, rheumatoid arthritis or other conditions
- Low vitamin D and calcium, low body weight, smoking and heavy alcohol use
- A previous fragility fracture, which sharply raises the chance of the next one
- Cancer that has spread to bone, which has to be excluded when a fracture occurs without enough osteoporosis to explain it
When to act
Stop waiting when this happens.
Do not sit on these
Any one of the following is a reason to be seen rather than to wait it out.
- Sudden new severe back pain in anyone with osteoporosis, which needs imaging rather than waiting, because a fracture cannot be ruled out on history alone
- Any weakness in a leg, numbness in the groin or inner thighs, or a change in bladder or bowel control alongside a known or suspected fracture, which is an emergency and needs same day care
- Pain that rest and over the counter medication are not controlling after a week or two
- Height loss, a new forward curve of the upper back, or pain that keeps returning at a new level each time
- A history of cancer, unexplained weight loss or fever with the back pain, which needs urgent evaluation before anything is injected
Diagnosis
Finding the actual source.
A diagnosis is not a guess from an image. It comes from the exam, the history and, where nerves are involved, electrodiagnostic testing.
- Pressing along the spine one level at a time, since a fresh compression fracture is usually tender over a single spinous process rather than a broad region
- X-ray of the thoracic and lumbar spine, taken standing where possible, which shows the loss of vertebral height
- MRI, which is what distinguishes a new fracture that is still healing and still generating pain from an old healed one, and that distinction decides the treatment
- A neurological exam of both legs to confirm the collapsed bone is not pressing on the spinal cord or a nerve root
- Bone density testing and the blood work that goes with it, ordered and managed by your primary care physician, endocrinologist or rheumatologist rather than here
- Looking for causes other than osteoporosis, including cancer and infection, when the fracture pattern, the age or the history does not fit
Nerve testing happens here, not elsewhere
EMG and nerve conduction studies are done in the office and read by Dr. Sheikh the same day, rather than sent out and waited on.
Treatment
How compression fractures is treated.
Ordered from the most common first step to the options reserved for pain that has not responded.
15–45 minNerve BlockA nerve block is an injection of local anesthetic, often with a steroid, placed next to a specific nerve or c…Read more →
Facet Joint InjectionA facet joint injection treats the small paired joints at the back of the spine that let you bend and twist.Read more →
Trigger Point InjectionA trigger point injection treats a knot in a muscle, a tight band that will not release and that often refers…Read more →
15–30 minEpidural Steroid InjectionAn epidural steroid injection puts anti-inflammatory medication into the epidural space, the area just outsid…Read more →Questions
Osteoporosis and Compression Fractures, answered.
Do you treat my osteoporosis?
No, and it is worth being clear about that. Bone density medication, calcium and vitamin D management and monitoring belong with your primary care physician, endocrinologist or rheumatologist, and they should stay in charge of it. What Dr. Sheikh manages is the pain from the fractures osteoporosis causes, working alongside the physician treating your bone. If you do not have anyone managing the osteoporosis, that needs arranging, because treating the pain without treating the bone leaves you waiting for the next fracture.
How long does a compression fracture hurt?
Most settle substantially over six to twelve weeks as the bone heals, with the sharpest pain in the first few weeks. Some leave a lasting ache from the change in spinal alignment even after the bone has healed. If the pain is still severe beyond about six weeks, that is worth reassessing rather than waiting out, because it often means the fracture is still unstable or a new level has given way.
What is kyphoplasty and do I need it?
Kyphoplasty and vertebroplasty are procedures in which cement is placed into the collapsed vertebra to stabilize it. They are considered when the fracture is recent, still shows as active on MRI, and the pain is severe and not improving with time and medication. They are not appropriate for an old healed fracture, which is exactly why the MRI matters before anyone decides. Where it is the right answer, you will be directed to the physician who performs it.
When is back pain with osteoporosis an emergency?
Any weakness in a leg, numbness in the groin or inner thighs, or a change in bladder or bowel control means the collapsed bone or its fragments may be compressing the spinal cord or nerve roots. That needs emergency care the same day, not an appointment next week. Fever with back pain, or back pain with a history of cancer and unexplained weight loss, also needs urgent evaluation rather than a routine visit.
Can injections help fracture pain?
They can, and they are aimed at specific pain sources rather than at the fracture itself. Blocks of the nerves running along the ribs, injections around the facet joints that are overloaded as the spine settles, and trigger point injections into the muscles working overtime to hold you upright all have a role. What they buy is enough relief to stay upright and moving while the bone heals, which matters because immobility worsens bone loss. They are one part of a plan that still includes the physician treating your osteoporosis.
Get a real diagnosis for compression fractures.
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