Osteoporotic Vertebral Compression Fracture

Definition

Vertebral body fracture from minimal trauma in osteoporotic bone, most often at the thoracolumbar junction.

Epidemiology

  • The most common fragility fracture
  • Many are asymptomatic and found on imaging
  • A vertebral fracture raises the risk of further vertebral and hip fracture

Classification

Genant semiquantitative grade by height loss

GradeSeverityHeight loss
1Mild20 to 25%
2Moderate25 to 40%
3SevereOver 40%

Original publication Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-48.

Clinical Features

  • Acute back pain after minor trauma or lifting
  • Pain on standing, eased supine, with local tenderness
  • Height loss and progressive kyphosis
  • Neurological deficit is uncommon. Consider retropulsion or a pathological fracture

Investigations

  • Standing radiographs for height loss and kyphosis
  • MRI with STIR sequences to show acute fractures and exclude malignancy
  • DEXA, and bloods for secondary causes including calcium, vitamin D, PTH and a myeloma screen

Management

  • Conservative care. Analgesia and early mobilisation, with a brace if it relieves pain
  • Vertebroplasty. Two blinded sham controlled trials (131 and 78 patients) found no benefit over sham at 1 and 3 months
  • Balloon kyphoplasty. FREE trial of 300 patients found a 5.2 point greater SF-36 physical gain at 1 month than nonoperative care
  • Surgery. Neurological deficit or progressive kyphosis with instability
  • Secondary prevention. Treat osteoporosis with bisphosphonate, denosumab or teriparatide, with calcium and vitamin D

References

Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009, 361(6), 569-79. PubMed

Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009, 361(6), 557-68. PubMed

Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009, 373(9668), 1016-24. PubMed

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 21 October 2026.