Bone Health After a Compression Fracture

What you are treating

A compression fracture is a collapse of the front of a vertebra, usually in the mid or low back, in a bone weakened by osteoporosis. It can happen from a minor fall, lifting a bag, or sometimes with no event at all. The pain is sharp at first, worse with standing and walking, and eases over six to twelve weeks as the bone heals. Most people recover with pain control and time.

The fracture itself is the smaller problem. The bigger one is what it says about the bone. A person who has had one compression fracture has about five times the risk of having another within the next year. The most important part of this plan is making sure the next fracture does not happen.

The first weeks: pain and movement

• Short rest, then move. A day or two of rest is fine. After that, walk short distances several times a day, building up. Long bed rest weakens bone and muscle quickly and raises the risk of blood clots and pneumonia.
• Pain medicine: acetaminophen on a schedule. An anti-inflammatory for short periods if your stomach, kidneys, and heart allow. A short course of a stronger medicine for the first one to two weeks if needed, with a bowel plan. Calcitonin nasal spray eases fracture pain for some people in the first weeks.
• A brace: a simple extension brace or a firm back support can make standing and walking more comfortable in the first few weeks and is reasonable to use for comfort. It does not change how the bone heals, and it is not needed in bed. Wean it as pain settles, usually by six weeks, so the back muscles do not weaken.
• Log-roll to get out of bed. Avoid bending forward and lifting while the fracture is fresh.
• Heat for muscle spasm. Sleeping on your back with pillows under the knees, or on the side with a pillow between the knees.
• Physical therapy after the first two to three weeks: extension-based posture exercises, back-muscle strengthening, hip strength, and balance training. Avoid sit-ups, toe-touches, and forward-bending exercise, which load the front of the vertebrae.

When kyphoplasty makes sense

If pain from the fracture is still severe after two to four weeks of this plan, and the fracture is the clear source on an MRI, a kyphoplasty can help. Through a small needle, a balloon lifts the collapsed bone and bone cement stabilizes it. Pain relief is often quick. It is an outpatient procedure. It is not needed for most fractures, which heal on their own, and it does not treat the osteoporosis. My guide to kyphoplasty and vertebroplasty explains it.

Preventing the next fracture

This is the part that matters most, and the part most often skipped. A compression fracture from a minor fall means osteoporosis, whatever the bone density number says, and it deserves treatment.

• A bone density test (DEXA) within the first weeks, if you have not had one in the past two years, and blood tests for vitamin D, calcium, kidney function, and a few causes of bone loss.
• Vitamin D: most people need 1,000 to 2,000 units a day to keep a blood level in the healthy range.
• Calcium: about 1,200 mg a day from food first (dairy, fortified foods, greens, canned fish with bones), with a supplement only to make up the difference.
• Bone medicines: after a fracture, medicine that strengthens bone cuts the risk of the next fracture by about half or more. The options include weekly or yearly medicines that slow bone loss, and daily injections that build new bone, which are often the better choice right after a fracture. Your primary doctor or an endocrinologist chooses with you. If you ever need spine surgery, a course of bone-building medicine before it makes the screws hold better.
• Protein: older adults heal and keep muscle better with protein at each meal.
• No smoking, and alcohol at no more than one drink a day.
• Fall prevention: remove loose rugs and cords, light the stairs and the path to the bathroom, wear shoes with grip, have your vision checked, review medicines that cause dizziness with your doctor, and do balance exercises such as tai chi. Most hip and spine fractures start with a fall at home.
• Exercise for bone: walking, stair climbing, and resistance training with weights or bands, two to three times a week, build and keep bone. Swimming and cycling are good for the heart but do not load bone.
• Posture: a daily routine of standing tall, shoulder-blade squeezes, and gentle back extensions over a rolled towel reduces the rounding that follows compression fractures.

What to watch for

• Pain that is not improving after six weeks, or that suddenly worsens: the fracture may be collapsing further or a new one may have occurred.
• A new, lower height or a more rounded back.
• Leg weakness, numbness, or trouble walking, which can mean the collapsed bone is pressing on the nerves. This needs prompt evaluation.
• Fever, unexplained weight loss, or a history of cancer with a spine fracture, which means the fracture needs a closer look at its cause.

Learn more

Bone Health and Osteoporosis Foundation: bonehealthandosteoporosis.org (opens in a new tab)

OrthoInfo, Osteoporosis and Spinal Fractures: orthoinfo.aaos.org (opens in a new tab)

My guide to osteoporotic vertebral compression fracture.

This plan is general guidance for Dr. Wey's patients and does not replace the advice we discuss in clinic. Bone medicines are prescribed and monitored by your primary doctor, endocrinologist, or Dr. Wey's team; do not start or stop them from this sheet.