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<div id="topicContent" class="utdArticleSection utdStyle xhash_topicContent_scrollTarget"><div id="topicTitle">Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment</div> <span class="view"><div data-v-2a07518f="" data-v-a20af505="" class="view-in-language ds1-pa-compact ds1-utd-size-1 wk-js2"><div data-v-80b97b5e="" data-v-2a07518f="" class="wk-field wk-field-is-inline wk-field-small" input-id="view-in-language" label="Topic Language" name="view-in-language" hide-header=""><!----> <div data-v-80b97b5e="" class="wk-field-body"><div data-v-80b97b5e="" class="wk-field-select-container"><select data-v-80b97b5e="" id="view-in-language" tabindex="0" aria-label="Select Topic Language option" class="wk-field-select view-in-language-selector" name="view-in-language" placeholder="Select Language"><option data-v-80b97b5e="" disabled="" value="">Select Language</option> <option data-v-80b97b5e="" value="/contents/zh-Hans/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment">Chinese</option><option data-v-80b97b5e="" value="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment">English</option></select></div> <div data-v-80b97b5e="" class="wk-field-inlay"><span data-v-80b97b5e="" class="wk-field-icon wk-field-check-mark-icon"><!----></span></div> <!----></div></div></div></span><div class="authorSectionElem"><div class="authorsElementsLeft"><dl id="topicContributors"><dt><span> </span>Author:</dt><dd><a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/contributors" class="contributor contributor_credentials" target="_blank" rel="noopener noreferrer">Harold N Rosen, MD</a></dd><dt><span> </span>Section Editor:</dt><dd><a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/contributors" class="contributor contributor_credentials" target="_blank" rel="noopener noreferrer">Clifford J Rosen, MD</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/contributors" class="contributor contributor_credentials" target="_blank" rel="noopener noreferrer">Katya Rubinow, MD</a></dd></dl><div id="literatureReviewDate"><div class="litReviewSingleLine"><bdi><span class="emphasis">Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div class="litReviewSingleLine"><bdi><span class="emphasis">This topic last updated:</span>&nbsp;Feb 11, 2025.</bdi></div></div></div></div><div id="topicText"><p class="headingAnchor css_h1" id="xhash_H1"><span class="h1 xhash_H1_scrollTarget">INTRODUCTION</span></p><p class="css_h1">Osteoporotic fractures (fragility fractures, low-trauma fractures) are those occurring from a fall from a standing height or less, without major trauma such as a motor vehicle accident. Vertebral compression fractures are the most common type of osteoporotic fracture [<a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/abstract/1" class="abstract_t">1</a>]. They often occur at the midthoracic (T7-T8) spine and the thoracolumbar junction (T12-L1). Fractures may result in significant back pain, limited physical functioning and activities of daily living, and can lead to loss of independence, depression, and chronic pain. Osteoporotic fracture is an important risk factor for subsequent fracture.</p><p class="css_h1">This topic will review the clinical manifestations, diagnosis, and management of acute osteoporotic vertebral compression fractures. The diagnosis and treatment of osteoporosis are reviewed separately. (See  <a href="/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-postmenopausal-women?search=vertebral+compression+fracture&amp;topicRef=7775&amp;source=see_link" class="medical medical_review">"Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women"</a> and  <a href="/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men?search=vertebral+compression+fracture&amp;topicRef=7775&amp;source=see_link" class="medical medical_review">"Clinical manifestations, diagnosis, and evaluation of osteoporosis in men"</a> and  <a href="/contents/overview-of-the-management-of-low-bone-mass-and-osteoporosis-in-postmenopausal-women?search=vertebral+compression+fracture&amp;topicRef=7775&amp;source=see_link" class="medical medical_review">"Overview of the management of low bone mass and osteoporosis in postmenopausal women"</a> and  <a href="/contents/treatment-of-osteoporosis-in-men?search=vertebral+compression+fracture&amp;topicRef=7775&amp;source=see_link" class="medical medical_review">"Treatment of osteoporosis in men"</a>.)</p><p class="headingAnchor css_h1" id="xhash_H2"><span class="h1 xhash_H2_scrollTarget">CLINICAL MANIFESTATIONS</span></p><p class="headingAnchor2 css_h1" id="xhash_H3"><span class="h2 xhash_H3_scrollTarget">Symptoms and signs</span><span class="headingEndMark">&nbsp;—&nbsp;</span>Acute vertebral body compression fractures are associated with pain. The pain may be tolerable and resolve without medical intervention (but the patient can often recall the episode of pain when a fracture is incidentally found on other imaging), or the pain may be incapacitating, requiring hospital admission and parenteral opioids. In contrast, osteoporotic vertebral compression that occurs slowly over time is often asymptomatic. Old or healed fractures may be an incidental finding on radiographs of the chest or abdomen. In other patients, the presence of vertebral fractures may become apparent because of height loss or kyphosis [<a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/abstract/2" class="abstract_t">2</a>]. (See <a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment?search=vertebral%20compression%20fracture&amp;source=search_result&amp;selectedTitle=1~150&amp;usage_type=default&amp;display_rank=1#H4" class="local" data-see-link-view-event="">'Height loss'</a> below and <a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment?search=vertebral%20compression%20fracture&amp;source=search_result&amp;selectedTitle=1~150&amp;usage_type=default&amp;display_rank=1#H5" class="local" data-see-link-view-event="">'Kyphosis'</a> below.)</p><p class="css_h1">In patients who have acute symptomatic vertebral body fracture, there is often no history of preceding trauma. The typical patient presents with acute back pain after sudden bending, coughing, or lifting. Occasionally, minor trauma, such as going over speed bumps, may precipitate a fracture [<a href="/contents/osteoporotic-thoracolumbar-vertebral-compression-fractures-clinical-manifestations-and-treatment/abstract/3" class="abstract_t">3</a>]. The pain is usually well localized to the midline spine but often refers in a unilateral or bilateral pattern into the flank, anterior abdomen, or the posterior superior iliac spine. By contrast, radiation of pain into the legs, as may be seen with a herniated disc, is rare with compression fractures but may herald spinal cord or nerve root compression from retropulsed bone fragments.</p><p class="css_h1">The pain from a vertebral compression fracture is variable in quality and may be sharp or dull. Sitting, spine extension, Valsalva maneuver, and movement often aggravate the pain and may be accompanied by muscle spasms. Sleep may be disturbed by pain. On physical examination, the patient may experience pain upon palpation and percussion of the corresponding spinous process and paravertebral structures.</p><a id="xhash_H4" class="headingAnchor emptyAnchor xhash_H4_scrollTarget"></a><a id="xhash_H5" class="headingAnchor emptyAnchor xhash_H5_scrollTarget"></a><a id="xhash_H6" class="headingAnchor emptyAnchor xhash_H6_scrollTarget"></a><a id="xhash_H7" class="headingAnchor emptyAnchor xhash_H7_scrollTarget"></a><a id="xhash_H3317740101" class="headingAnchor emptyAnchor xhash_H3317740101_scrollTarget"></a><a id="xhash_H8" class="headingAnchor emptyAnchor xhash_H8_scrollTarget"></a><a id="xhash_H9" class="headingAnchor emptyAnchor xhash_H9_scrollTarget"></a><a id="xhash_H10" class="headingAnchor emptyAnchor xhash_H10_scrollTarget"></a><a id="xhash_H1565673" class="headingAnchor emptyAnchor xhash_H1565673_scrollTarget"></a><a id="xhash_H2913259202" class="headingAnchor emptyAnchor xhash_H2913259202_scrollTarget"></a><a id="xhash_H1565696" class="headingAnchor emptyAnchor xhash_H1565696_scrollTarget"></a><a id="xhash_H1565702" class="headingAnchor emptyAnchor xhash_H1565702_scrollTarget"></a><a id="xhash_H1565708" class="headingAnchor emptyAnchor xhash_H1565708_scrollTarget"></a><a id="xhash_H1565714" class="headingAnchor emptyAnchor xhash_H1565714_scrollTarget"></a><a id="xhash_H1565876" class="headingAnchor emptyAnchor xhash_H1565876_scrollTarget"></a><a id="xhash_H12" class="headingAnchor emptyAnchor xhash_H12_scrollTarget"></a><a id="xhash_H13" class="headingAnchor emptyAnchor xhash_H13_scrollTarget"></a><a id="xhash_H3771713562" class="headingAnchor emptyAnchor xhash_H3771713562_scrollTarget"></a><a id="xhash_H14" class="headingAnchor emptyAnchor xhash_H14_scrollTarget"></a><a id="xhash_H15" class="headingAnchor emptyAnchor xhash_H15_scrollTarget"></a><a id="xhash_H16" class="headingAnchor emptyAnchor xhash_H16_scrollTarget"></a><a id="xhash_H18" class="headingAnchor emptyAnchor xhash_H18_scrollTarget"></a><a id="xhash_H17476627" class="headingAnchor emptyAnchor xhash_H17476627_scrollTarget"></a><a id="xhash_H17476834" class="headingAnchor emptyAnchor xhash_H17476834_scrollTarget"></a><a id="xhash_H17476846" class="headingAnchor emptyAnchor xhash_H17476846_scrollTarget"></a><a id="xhash_H753943238" class="headingAnchor emptyAnchor xhash_H753943238_scrollTarget"></a><a id="xhash_H974428" class="headingAnchor emptyAnchor xhash_H974428_scrollTarget"></a><a id="xhash_H20" class="headingAnchor emptyAnchor xhash_H20_scrollTarget"></a><a id="xhash_H21" class="headingAnchor emptyAnchor xhash_H21_scrollTarget"></a><a id="xhash_H26112238" class="headingAnchor emptyAnchor xhash_H26112238_scrollTarget"></a><a id="xhash_H22" class="headingAnchor emptyAnchor xhash_H22_scrollTarget"></a><a id="xhash_H23" class="headingAnchor emptyAnchor xhash_H23_scrollTarget"></a><a id="xhash_H1405649975" class="headingAnchor emptyAnchor xhash_H1405649975_scrollTarget"></a><a id="xhash_H1189451" class="headingAnchor emptyAnchor xhash_H1189451_scrollTarget"></a><a id="xhash_H25" class="headingAnchor emptyAnchor xhash_H25_scrollTarget"></a><a id="xhash_H3937992473" class="headingAnchor emptyAnchor xhash_H3937992473_scrollTarget"></a></div><div data-v-a20af505="" id="subscribeInterrupt" class="subscribe-message-banner"><div class="subscribe_header_message">To continue reading this article, you must sign in with your personal, hospital, or group practice subscription.</div> <!----> <div class="subscribe-interrupt-login-register-section"><div class="login-register-section-item"><a data-v-e300e72a="" href="/store" class="utd-button utd-button-link utd-button-size-large utd-button-color-green-shade-3 utd-button-style-default link-button-1" track="enabled" role="button"><!----> <span data-v-e300e72a="" class="utd-button-link-text"><!----> Subscribe</span> <!----></a></div> <div class="login-register-section-item"><a data-v-e300e72a="" href="/login" class="utd-button utd-button-link utd-button-size-large utd-button-color-blue utd-button-style-default link-button-2" track="enabled" role="button"><!----> <span data-v-e300e72a="" class="utd-button-link-text"><!----> Sign in</span> <!----></a></div></div></div><div id="disclaimer" class="xhash_disclaimerContent_scrollTarget">Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. 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