• Osteoporosis is a decline in overall bone mass in the axial and appendicular skeleton
  • Affects 15-20 million people in the US
  • Peak bone mass is reached between ages 16-25 years
  • With age, bone resorption exceeds bone formation
  • Women are at increased risk in the 15-20 years after menopause, directly linked to estrogen deficiency
  • Certain environmental factors may accelerate osteoporosis:
  • Chronic calcium deficiency
  • Smoking
  • Excessive alcohol intake
  • Hyperparathyroidism
  • Inactivity
  • Genetic influences
  • Vertebral compression fractures are one of most frequent manifestations of osteoporosis in elderly with >700,000 compression fractures annually
  • Most patients are asymptomatic


  • Symptomatic compression fractures involve pain localized to fractured level
  • Frequently no history of trauma or inciting event
  • Often family members will notice the patient’s back becoming progressively more rounded (kyphotic)
  • This spinal deformity is known as “dowager’s hump” (right)
  • Generally there is no neurologic dysfunction and no radiation of pain in dermatomal patterns


  • Plain radiographs and densitometric scans are major imaging modalities
  • Dual-energy x-ray absorptiometry (DEXA scan) has been most useful form of densitometric scans due to its high presicion (0.5-2%) and minimal amounts of radiation
  • DEXA scan assesses and quantitates osteoporosis
  • AP & Lateral plain films of affected area demonstrate severity of osteoporotic fractures(s)
  • MRI is valuable in evaluation of persistently painful, non-united, or pathologic fractures
  • MRI is also helpful in determining the acuity of a compression fracture seen on plain film

Severe T-11 compression fracture with marked wedging and kyphosis


  • Osteoporosis
  • Prevention is the best treatment for osteoporosis
  • Maximizing bone density prior to onset of bone loss is optimal regimen
  • Estrogen replacement is controversial but is effective at halting the post-menopausal decline in bone density in women
  • Calcitonin and parathyroid hormone are effective therapies in certain patients
  • Bisphosphonates (etidronate and alendronate) prevent osteoclastic resorption of bone
  • Bisphosphonates are the only FDA approved pharmacotherapy for increasing bone density. Unfortunately, the increase is small

Vertebral Compression Fractures

  • Initial treatment involves analgesics therapy and bracing for comfort
  • Evaluation and treatment for osteoporosis should be initiated
  • Surgical treatment is required compression fractures with associated neurologic compromise or spinal cord compression
  • Anterior decompression and fusion with possible posterior fusion
  • Patients with persistent pain after conservative therapy may undergoe percutaneous stabilizing techniques
  • polymethylmethacrylate (PMMA) bone cement is injected into the fracture percutaneously through pedicles into vertebral body under fluoroscopic guidance
  • Vertebroplasty
  • Kyphoplasty
  • Both methods show excellent symptomatic relief and have shown to be safe and efficacious