A compression fracture is a small break in one of the bones (vertebrae) that make up your spine, where the bone partially collapses or cracks under pressure. The front of the vertebra typically crushes down while the back stays intact, giving the bone a wedge shape instead of its normal rectangular block shape. These fractures happen most often in the middle and upper back and are the most common type of fracture caused by weakened bones.
How the Vertebra Breaks
Your spine is a column of 24 stacking bones, each separated by a cushioning disc. Each vertebra is designed to bear weight from above while protecting the spinal cord running through its center. A compression fracture occurs when downward force exceeds the structural strength of the bone, causing the front portion of the vertebra to collapse. On an X-ray, a healthy vertebra looks like a rectangle from the side. A compressed one looks more like a trapezoid or wedge, shorter in the front than the back.
This collapse can be subtle, with just a few millimeters of height lost, or severe enough to reduce the vertebra to half its original height. The fracture may involve a single vertebra or, over time, affect several in a row.
What Causes Compression Fractures
Osteoporosis is the leading cause. When bone mineral density drops low enough, vertebrae can fail under normal everyday forces: bending to pick something up, sneezing hard, or stepping off a curb. The bone is simply too weak to handle loads it once managed easily. This is why compression fractures are sometimes called fragility fractures. They are most common in older adults, particularly postmenopausal women.
In younger people, compression fractures almost always come from high-energy trauma like car accidents or falls from significant heights. The force involved is enough to crush a healthy vertebra. This creates a bimodal pattern: the condition primarily affects older people with weak bones and younger people involved in serious injuries.
A third cause is cancer that has spread to the spine or blood cancers like multiple myeloma. Tumors can erode the bone from within, hollowing it out until it collapses. When doctors find a compression fracture, they sometimes need imaging to rule out an underlying cancer, especially if the fracture seems out of proportion to any injury.
Symptoms to Recognize
The hallmark symptom is sudden back pain that gets worse when you move and improves when you lie down. The pain is typically localized to the fracture site, and pressing on that area produces tenderness. You may also notice stiffness and difficulty with movements like standing up, bending, or twisting.
Some compression fractures cause tingling or numbness if the collapse pinches a nearby nerve. Others, particularly mild ones in people with osteoporosis, produce so little pain that they go unnoticed for weeks or months. These “silent” fractures are often discovered incidentally on an X-ray taken for another reason.
Over time, multiple compression fractures stack their effects. Each collapsed vertebra shortens your spine slightly and tilts the one above it forward. This gradual process leads to a rounded upper back, sometimes called a dowager’s hump, along with measurable height loss. The curvature worsens with each additional fracture, and the severity increases as bone density decreases, creating a cycle where one fracture raises the risk of the next.
Risk of Additional Fractures
Having one compression fracture significantly raises the chance of getting another. Research has found that people with an initial compression fracture have a five-fold higher risk of developing additional fractures compared to people who have never had one. About 19 to 22 percent of patients experience a new fracture at a different spinal level within the first year, whether they were treated surgically or managed conservatively. This cascading risk is one reason doctors focus on treating the underlying bone weakness, not just the fracture itself.
How Compression Fractures Are Diagnosed
A standard X-ray is usually the first step. Doctors look for loss of vertebral height, the characteristic wedge shape, cortical fracture lines, and changes in spinal alignment. X-rays are good at confirming that a fracture exists and showing how much height has been lost, but they can’t tell you much about when it happened.
MRI is considered the gold standard for evaluating compression fractures in detail. It detects bone marrow edema, which is swelling inside the bone that signals an acute, recent fracture versus an old one that has already healed. This distinction matters for treatment decisions. MRI is also especially helpful for telling the difference between a fracture caused by osteoporosis and one caused by cancer. Malignant fractures tend to show tumor tissue replacing normal bone marrow, soft tissue masses around the vertebra, and a convex bulging of the back wall of the bone.
Conservative Treatment
Most compression fractures heal without surgery. About two-thirds of patients see their pain resolve within three to six weeks with nonsurgical management. The approach combines pain control, activity modification, and often a back brace to limit movement and keep the spine in a more upright position while the bone heals.
For pain relief, over-the-counter options like acetaminophen are generally preferred for longer-term use because of their safety profile. Anti-inflammatory medications can help but should be used for the shortest duration possible. During the healing period, you’ll likely need to avoid bending, lifting, and twisting. Rest helps, but prolonged bed rest is discouraged because it accelerates bone loss and muscle weakening.
When Procedures Are Needed
If pain persists despite several weeks of conservative care, two minimally invasive procedures can help. Both are performed through a small needle inserted into the fractured vertebra, typically as outpatient procedures.
- Vertebroplasty: A special bone cement is injected directly into the fractured vertebra to stabilize it. The goal is pain relief and preventing further collapse.
- Kyphoplasty: A balloon is first inflated inside the vertebra to create a cavity and partially restore the bone’s original height. Cement is then injected into that cavity under lower pressure, which may reduce the risk of cement leaking outside the bone.
Both procedures deliver similar pain relief. In pooled data covering nearly 6,000 treated fractures, about 87 percent of vertebroplasty patients and 92 percent of kyphoplasty patients reported at least some pain relief, with benefits lasting years. Kyphoplasty is sometimes chosen for more severe fractures because the balloon can restore some lost height and correct spinal curvature, but head-to-head comparisons show comparable pain outcomes between the two.
Recovery and Rebuilding Strength
Once the acute pain settles, physical therapy becomes the priority. A spine conditioning program typically runs four to six weeks and focuses on strengthening the muscles that support your back: the deep core muscles, the obliques along your sides and lower back, and the muscles running along the spine itself. Keeping these muscles strong helps stabilize the spine, relieve lingering pain, and protect against further injury.
Early rehabilitation usually starts with gentle range-of-motion exercises and progresses to more active strengthening as pain allows. High-impact activities, heavy lifting, and forward-bending exercises are generally avoided during recovery because they put compressive force on the healing vertebra. Your therapist will guide you on when it’s safe to return to normal activities, which for most people happens within two to three months of the fracture.
For people whose fracture was caused by osteoporosis, long-term management includes addressing the bone loss that made the fracture possible in the first place. This typically involves bone-strengthening medication, adequate calcium and vitamin D, and weight-bearing exercise to slow further density loss and reduce the risk of the next fracture.