Home / Conditions / Spinal compression fracture
A vertebra collapsing, usually at the front, into a wedge. Most follow a minor strain in bones weakened by osteoporosis — and one fracture makes the next more likely unless the bone is treated.
A compression fracture is a break in which a vertebra is squashed rather than snapped. Most often the front of the bone collapses more than the back, leaving it wedge-shaped. It usually happens in the middle or lower back, where the spine carries the most load.
In healthy bone, it takes a serious injury to do this. In bone weakened by osteoporosis, it can take very little: lifting shopping, bending to pick something up, a cough, or a misstep. Several wedged vertebrae together tip the spine forward into a stoop — one of the commonest causes of kyphosis in later life.
The vertebra at the top is intact. The two below it have cracked and collapsed, more at the front than the back — the wedge shape that tips the spine forward.
What a drawing cannot show is what comes next. After one vertebral fracture, the risk of another rises sharply, especially in the following year. That is why treating the bone matters as much as treating the pain.
Many compression fractures are never noticed. Around two in three cause little or no pain at the time and are found only on an X-ray taken for something else. Losing height is often the first sign. A fracture found this way still means the bone needs attention.
The same collapsed vertebra on an X-ray can come from three quite different causes. The first question is always which one.
| Osteoporotic | Injury | Disease in the bone | |
|---|---|---|---|
| Typical person | Older adults, especially women after menopause | Any age, often younger | Usually older, sometimes with a known cancer |
| What happened | A minor strain, or nothing noticed | A fall from height, a road accident, a sports injury | Often nothing, or a trivial movement |
| Warning signs | Previous fractures, height loss, long-term steroid use | Leg numbness or weakness after the injury | Night pain, weight loss, fever, or a history of cancer |
| First priority | Pain control, then treating the bone | Whether the spine is stable, and whether nerves are affected | Finding the cause |
Injuries can also cause a burst fracture, where the back wall of the vertebra breaks too. That type can be unstable and can push bone towards the spinal cord or nerves, so it is assessed differently from a simple wedge.
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After a serious injury — a fall from height or a road accident — do not wait for an appointment: go to an emergency department. The same applies if we are closed; we are shut on Sundays and after 1pm on Saturdays.
Call +65 8849 0677An X-ray cannot tell a new fracture from an old one. Many people with osteoporosis have both. MRI shows which vertebra is freshly broken — which matters when deciding whether a procedure could help, and at which level.
Spine fracture treatment depends on the cause. Most osteoporotic compression fractures heal without surgery over roughly six to twelve weeks, with the worst pain easing in the first few.
Enough pain relief to keep moving. A day or two of rest may be needed, but long periods in bed weaken bone and muscle further, especially in older people. Stronger painkillers are used with care because of drowsiness, constipation and the risk of falls.
Some people find a brace eases pain in the first weeks. It supports; it does not make the bone heal faster, and it is not worn for long.
Once the pain allows: strengthening the back muscles that hold the spine upright, posture, and balance work to reduce the risk of falls.
The step most likely to prevent the next fracture. After one vertebral fracture, the risk of another in the following year is several times higher. A bone density scan, calcium and vitamin D, and bone-strengthening medicine reduce that risk. See osteoporosis.
Vertebroplasty and kyphoplasty inject bone cement into the broken vertebra through a needle; kyphoplasty first raises it with a small balloon. They are considered for a recent fracture, confirmed on MRI, whose pain has not settled with the steps above. The evidence is mixed: in trials comparing vertebroplasty with a sham procedure, many patients did no better, so careful selection matters.
For an unstable fracture, bone pressing on the spinal cord or nerves, or a severe or worsening deformity: decompression, and fixation with screws and rods to hold the spine while it heals. Where disease in the bone is the cause, treatment is directed at that as well.
A fracture is a structural problem, and fractures sit on the orthopaedic side. The neurosurgical side comes in where the broken bone, or disease within it, threatens the spinal cord or nerves.
The collapse, its stability, the curve it causes, bracing, and the bone itself.
An orthopaedic spine surgeon trains on the musculoskeletal system first. Dr Lim Heng Hing treats spinal compression fractures and osteoporosis.
Leg numbness or weakness from bone pushed into the spinal canal, or a fracture caused by a tumour.
A neurosurgeon trains on the nervous system first. Dr Mathew Tung performs spinal decompression and fusion, and laminectomy for spinal tumours.
For a fracture on its own, the orthopaedic side is the natural start. With leg symptoms, or a known cancer, either is a sound first appointment. Having both surgeons in one clinic means the answer is not shaped by whichever one you happened to book.
More on how the two differ: neuro spine and orthopaedic spine surgery.
Most osteoporotic compression fractures heal in about six to twelve weeks, with the worst pain easing in the first few. The height the vertebra has lost does not come back on its own.
Yes. In bone weakened by osteoporosis, lifting, bending, coughing or a misstep can be enough. Some fractures happen with no event anyone notices.
Only briefly, if at all. Long periods in bed weaken bone and muscle and raise the risk of other complications, particularly in older people. Staying on your feet with enough pain relief is better.
Most people do not. Cement augmentation is considered for a recent fracture whose pain has not settled; surgery is for fractures that are unstable or pressing on nerves.
The risk is higher after a first vertebral fracture, especially in the following year. Treating the underlying osteoporosis is what lowers it, along with exercise and preventing falls.
No. Bring any X-ray, MRI or bone density reports, and a list of your medicines — particularly steroids or anything for bone health.
Osteoporosis · Kyphosis · Back pain · Lower back pain · Scoliosis · Spinal stenosis
If you have had a fracture before, or have lost height, mention it when you book. It changes what gets checked.
