Do This to Avoid Compression Fractures in Your Spine

Vertebral compression fractures are common as people age thanks to lower bone density. Here are some strategies to prevent them.

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Although hip and wrist fractures get a great deal of attention when it comes to osteoporosis—and they should, since they’re very real risks of the condition—spinal fractures occur almost twice as often, affecting nearly 700,000 people each year, according to the American Academy of Orthopaedic Surgeons (AAOS).

Doctor showing postmenopausal woman how to avoid compression fracturesCompression fractures become more of a risk as you age thanks to lower bone density.

Also called fragility fractures, vertebral compression fractures, or osteoporotic compression fractures, these usually occur as a result of thinning and weakening bones caused by osteoporosis.

The AAOS notes that changes in bone can go unnoticed over many years, leading to vertebrae becoming more narrow and flatter, and as the spine rounds as a result, it created compression. Because of the weakened bone, that pressure can cause a crack, even from everyday, low-impact motions like reaching, coughing, or twisting.

Just because bones lose density as you age doesn’t mean these kind of fractures are inevitable, though. There are strategies that can help prevent not only osteoporosis but also osteoporotic compression fractures.

Move More

If there is one tactic that everyone should pursue, it’s more movement, says Neel Anand, MD, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles.

“This does not mean gentle movement that you do occasionally as a break from sitting,” he states. “To improve spine health, you need full range of motion and to load your bones so they can get stronger.”

That might mean walking more, which gives the spine resistance, Dr. Anand says. He also recommends using light weights with high reps—even five to 10 pounds of a load is enough to challenge the spine without muscle stress. He’s a fan of yoga, Pilates, tai chi, hiking, swimming, and any other exercise that can help you move in different directions.

“Some people think they need to rest more as they get older, but the opposite is true for building bone density in a way that prevents osteoporotic compression fractures,” he says. “Get on your feet and move, for probably 10 to 15 minutes every hour.”

Incorporating more activity and focusing on healthy diet changes can have the added benefit of shedding excess weight, says Dr. Anand. That can decrease pressure on the spine and lower fracture risk, as well as improve osteoporosis overall.

If you have osteoporosis at the spine, it is important to review your exercise plans with your physician to ensure that they are safe. The wrong types of movement or too much stress on a fragile spine can cause a fracture.

Review Medications and Other Conditions

There are some medications that can help build bone density, but a few medications for other conditions can actually cause faster loss, according to Emily Stein, MD, an endocrinologist and bone specialist at the Hospital for Special Surgery in New York City.

“People may be taking a medication that’s good for another issue they have, but not realizing that it may be associated with a reduction in bone density,” she says. “That’s why it’s important to review your prescriptions with your doctor with that potential side effect in mind.”

Some medications that may cause bone loss include:

  • Glucocorticoids
  • Aromatase inhibitors for breast cancer, such as anastrozole, letrozole, and exemestane
  • Androgen deprivation therapy for prostate cancer
  • Proton pump inhibitors
  •  Depo-Provera for contraception
  •  Some anti-seizure drugs like carbamazepine and phenytoin
  •  Diuretics like furosemide

Another important consideration is to review other underlying conditions that may be affecting osteoporosis, Dr. Stein adds. For example, the National Institutes of Health (NIH) notes that people with diabetes, particularly type 1, often have poor bone quality and increased risk of fractures. 

Add Calcium, Lose the Smokes

Ensuring adequate intake of calcium is essential for osteoporosis prevention, and subsequently, lower risk of fragility fractures, says Dr. Stein. She notes that low calcium intake can contribute significantly to lower bone density and to faster bone loss during aging. Adequate intake of  vitamin D is also helpful.

One lifestyle habit that seems to speed up calcium depletion is smoking, which is one of the reasons it’s often cited as detrimental to spine health and fracture prevention. The NIH notes that cigarette smoking was first identified as an osteoporosis risk factor decades ago, since there’s a direct relationship between decreased bone density and tobacco use.

Treatment Directions

If you suspect you’re already dealing with a compression fracture, your doctor can confirm that diagnosis through imaging tests like X-rays, magnetic resonance imaging (MRI) scans, a bone scan, or a computed tomography (CT) scan. If you haven’t already been diagnosed with osteoporosis, you’ll likely also be a candidate for bone density testing with dual-energy x-ray absorptiometry (DEXA) which will determine bone mineral density.

If a scan reveals you have a vertebral compression fracture, the most common treatment is actually no treatment at all. According to the AAOS, most people with this type of issue get better within three months with a short period of rest and limited use of pain medications. Some patients wear braces to restrict movement so the fracture can heal without added compression or strain.

For those who don’t respond to nonsurgical treatment, minimally invasive surgery may be an option, says Dr. Anand. In either case, your doctor will likely suggest measures like the ones above to help with bone strengthening to prevent issues in the future. 

Updated on: 04/12/21
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Osteopenia and Osteoporosis: Is There a Difference?
Emily Stein, MD
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