Vertebral height loss (VHL) is a condition where one or more of the bones, called vertebrae, shorten or collapse. The spine is a column of these small bones stacked upon each other, separated by intervertebral discs that act as cushions. When the vertebrae lose height, it affects the entire structure of the back and can lead to significant changes in health and mobility. This shortening is a common concern, particularly as people age, and is frequently related to changes in bone strength. Understanding the causes and treatments for this spinal compression is important for maintaining a healthy and active lifestyle.
Understanding Vertebral Height Loss
Vertebral height loss occurs when the bony vertebral body collapses, often due to a spinal compression fracture, leading to a measurable reduction in the bone’s vertical dimension. While some minor height loss can happen gradually from the thinning of the cushioning discs, significant or acute loss is typically a sign of a fracture. A vertebral fracture is defined as a loss of height exceeding 20% in the affected bone.
When one or more vertebrae collapse, the physical manifestations become apparent. The most common symptom is acute or chronic back pain, which often feels worse when standing or walking and may be relieved when lying down. Multiple fractures can lead to a noticeable reduction in overall height and a change in posture, resulting in kyphosis, a forward curvature of the upper spine often called a “dowager’s hump.” This change in spinal alignment can also cause complications such as crowding of internal organs, potentially leading to digestive issues or difficulty breathing.
Principal Causes of Vertebral Compression
The primary cause of vertebral compression fractures and subsequent height loss is osteoporosis, a condition characterized by low bone mass and structural deterioration. When bones are weakened by osteoporosis, they become susceptible to fragility fractures, meaning the vertebrae can collapse even from minimal stress. These fractures may occur during routine daily activities such as coughing, sneezing, or twisting, without any significant fall or accident.
The most common type is a wedge fracture, where the front portion of the vertebral body collapses, creating a wedge shape and contributing to the forward stoop. Other factors can also lead to vertebral compression. High-impact trauma, such as a severe fall or a car accident, can cause a fracture in a healthy spine. Furthermore, the presence of tumors, either primary or metastatic cancer that has spread to the spine, can weaken the bone structure and cause a pathological collapse.
Identifying and Measuring the Loss
Medical professionals rely on imaging techniques to confirm and quantify vertebral height loss. Standard X-rays (plain radiographs) are the initial and primary tool for visualizing the spine and measuring the extent of the compression. These images allow doctors to see the characteristic wedge shape or general flattening of the vertebral body.
Specific measurements, such as the anterior vertebral body compression percentage, are used to quantify the degree of collapse by comparing the fractured bone’s height to expected measurements. Imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) may be used for a more detailed assessment, especially if nerve involvement is suspected or if the cause is unclear. Dual-energy X-ray absorptiometry (DEXA) scans, often including a Vertebral Fracture Assessment (VFA), are utilized to measure bone mineral density, helping to confirm osteoporosis and assess the risk of future fractures.
Treatment Approaches for Spinal Compression
Treatment for vertebral compression fractures typically begins with conservative management aimed at pain relief and stability. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain medications are often prescribed to manage the acute discomfort. Physical therapy is frequently recommended to strengthen the muscles supporting the spine and improve posture, though care is taken to avoid exercises that involve excessive bending or twisting.
For fractures that do not respond to conservative measures, pharmacological treatments are employed to address the underlying bone weakness. Medications such as bisphosphonates are widely prescribed to slow the rate of bone loss and stabilize the skeleton. In certain instances, bone-building medicines that mimic natural hormones can be administered to actively stimulate new bone growth.
Minimally invasive surgical procedures are considered for painful fractures that do not heal or stabilize on their own. Vertebroplasty involves injecting a specialized bone cement directly into the fractured vertebra to stabilize it and reduce pain. Kyphoplasty is a similar procedure, but it first uses a small balloon to attempt to restore some of the lost vertebral height before the cement is injected. Both procedures are performed through a hollow needle and can provide rapid pain relief.
Strategies for Prevention and Long-Term Care
Long-term care and prevention focus heavily on strengthening bone health and minimizing the risk of falls. Adequate nutritional intake of calcium and Vitamin D is a foundational step, as these nutrients are necessary for bone density and strength. Calcium needs vary by age, but adults generally require about 1,000 to 1,200 milligrams per day, with Vitamin D helping the body absorb that calcium.
Regular exercise is another important component, specifically weight-bearing activities like walking or jogging, and resistance exercises that involve working the major muscle groups. These types of movement encourage the bones to maintain density and build muscle strength to support the spine. Fall prevention strategies are also important, particularly for older adults, and can include removing tripping hazards from the home and ensuring proper lighting. Avoiding habits like smoking and excessive alcohol consumption is also recommended, as they can negatively affect bone health and increase the likelihood of future fractures.