Thoracic Compression Fractures and Osteoporosis

For my blog this week I decided to write about thoracic vertebral compression fracture since this is a common reason for CT scans at my clinical site. Vertebral compression fractures are typically caused by osteoporosis and a severe fracture can cause a great deal of pain for the elderly patient. This pain can begin to interfere with the ability to perform tasks of daily living.

Vertebral fractures will affect 25% of postmenopausal women in the U.S. The risk increases with advancing age and rises to 40% by age 80. Of great concern is the mortality rate for these women. It is 15% higher than for the same age group without fractures.

Acute fractures usually occur with some trauma, like a fall, tripping over an object or a lifting injury. If the osteoporosis is severe something as simple as lying in bed or sneezing can cause a fracture. The force usually causes the anterior portion of the thoracic body to compress, forming a wedge. The fracture is considered “burst” if the entire vertebra compresses. Over time and with multiple fractures the patient will lose height and become kyphotic. Many fractures go undiagnosed because older patients may expect back pain as a sign of aging or arthritis.

Compression fractures in the thoracic area are usually in the T8 – T12 area. CT is usually used to confirm plain film and physical exam diagnosis, show spinal cord narrowing and assess the stability of a fracture. MR is used if the patient is showing symptoms of spinal cord impingement. Nuclear Medicine is also used for diagnosis because new fractures will appear “hot” on the scan but healed fractures will not.

Conservative treatment for stable fracture includes muscle relaxants, back brace, NSAID’s if well tolerated, and physical therapy. Mild exercise is encouraged once the fracture is fully healed. Some patients may require either vertebroplasty or kyphoplasty, where cement is injected into the collapsed vertebral body to increase stability. This CT image shows a thoracic compression fracture.

Image: http://www.urmc.rochester.edu/smd/Rad/neuroimages/CTT-spine.jpg accessed November 30, 2009

Reference: Old, J. & Calvert, M. (2003). Vertebral Compression Fractures in the Elderly. AAFP, January 1 2004. Accessed November 30, 2009 at http://www.aafp.org/afp/20040101/111.html