Lumbar Vertebral Fracture

A vertebral fracture is a break or collapse of a bone in the spine. It primarily affects individuals with bones weakened by osteoporosis or those who have experienced significant trauma. This injury leads to acute back pain, changes in posture, and limitations in daily activities. It requires a thorough medical evaluation and structured rehabilitation, including physiotherapy, to manage pain, restore mobility through safe, progressive exercises, strengthen supporting muscles, and implement strategies to prevent falls. To understand how vertebral fractures differ from other back problems, please consult our complete guide to back pain.

What is a Vertebral Compression Fracture?

A vertebral compression fracture occurs when a bone in the spine crushes or collapses, losing more than 15-20% of its normal height. This type of fracture primarily affects the thoracolumbar junction (T11-L2) in individuals with bones weakened by osteoporosis.¹

The spine is made up of bones called vertebrae. Each vertebra has a hard outer shell (cortical bone) and a spongy interior (trabecular bone). The spongy bone provides strength to the vertebra while keeping it lightweight. When too much pressure is applied, this interior collapses. This typically happens in the front part of the vertebra during bending movements.²

The thoracolumbar junction (T11-L2) is most prone to fractures because it serves as a transition zone between the rigid thoracic spine and the mobile lumbar spine. This region is subjected to significant mechanical stress during daily activities.³ The middle of the thoracic spine (T6–T8) also presents a high risk in people with lumbar osteoarthritis and osteoporosis. Multiple fractures can cause excessive forward curvature known as kyphosis (hunchback) and progressive loss of height.

What Causes Vertebral Fractures?

Osteoporosis causes the majority of vertebral fractures, accounting for approximately 700,000 fractures per year in the United States. Postmenopausal women are 2 to 3 times more at risk than men, and the risk increases significantly after age 60.^4,5 Vertebral fractures are common as people age, especially among women. About 12% of women aged 50 to 70 have had one, and up to 20% of those over 70.

The main causes include:

Osteoporosis (fragility fractures) A healthy young adult has bones that can withstand 6,000–8,000 Newtons of force. Advanced osteoporosis reduces this strength to less than 2,000 Newtons.⁶ In people with osteoporosis, fractures can occur during everyday activities such as coughing, sneezing, or leaning forward. A vertebral fracture often occurs after a minor injury: a slip, a misstep, or lifting a load while leaning forward. High-energy trauma Falls from heights, car accidents, and sports injuries generate enough force to fracture even healthy vertebrae in young adults.⁷ Pathological conditions Cancer can spread to the spine (metastases), creating areas of bone destruction that are prone to fractures. Breast, lung, prostate, and kidney cancers frequently spread to the spine.⁸ Repetitive loading Stress fractures affect some athletes who participate in gymnastics, rowing, or weight training.⁹

Category	Risk factors
Age and sex	Advanced age (especially over 60), female sex (2-3x higher risk)
Medical history	Previous vertebral fracture (5x higher risk), family history of osteoporosis
Medications	Prolonged use of corticosteroids (prednisone, cortisone)
Lifestyle	Smoking, excessive alcohol consumption, sedentary lifestyle, low body weight
Nutrition	Vitamin D deficiency, insufficient calcium intake

Certain habits increase the risk of fractures due to bone fragility. Smoking more than 20 cigarettes a day is one of them.

The good news? Most vertebral fractures heal well with proper care. Your body has a remarkable ability to repair bone.

What are the Symptoms of a Vertebral Fracture?

Vertebral fractures cause sudden, severe back pain (7–10/10) at the site of the fracture, which worsens with movement and is relieved by resting in a supine position. Chronic symptoms include progressive loss of height and a hunched posture.^10,11

Acute symptoms The pain peaks within a few hours of the fracture. Patients describe the pain as sharp, throbbing, or crushing. They can often pinpoint the exact moment the injury occurred. Worsening pain Leaning forward, getting up from a chair, and rolling over in bed make the pain worse. Lying on your back with proper support provides some relief. Chronic symptoms Each fracture can reduce the total height by 1–2 centimeters.¹² Multiple fractures lead to a cumulative loss of height and progressive thoracic kyphosis (giving the appearance of a "dowager's hump").¹³ Severe kyphosis reduces the volume of the rib cage, potentially causing shortness of breath during exertion, with an approximate 9% reduction in lung volume for each thoracic fracture.¹⁴ Silent Fractures About one-third of vertebral fractures are asymptomatic and are discovered incidentally during imaging performed for other reasons.¹⁶ Many spinal fractures go undetected: a significant number of people have no noticeable symptoms, and the fracture is discovered incidentally on an X-ray. That is why sudden-onset back pain in a person at risk for osteoporosis warrants evaluation.

Don't worry: even if the pain is intense at first, it usually subsides significantly within the first few weeks, and it's normal to feel limited at first. With time and the right exercises, you'll regain your mobility.

How are Vertebral Fractures Diagnosed?

The diagnosis is based on X-rays showing loss of vertebral height, an MRI to distinguish acute from chronic fractures, and a DEXA scan to assess underlying osteoporosis. The TLICS classification guides decisions regarding conservative or surgical treatment.¹⁷

X-rays The lateral views show the loss of vertebral body height and the fracture lines. A loss of height exceeding 15–20% indicates a fracture. Genant Classification Grade 1 (mild): 20–25% loss of height. Grade 2 (moderate): 25–40%. Grade 3 (severe): more than 40%.¹⁸ MRI (Magnetic Resonance Imaging) MRI definitively identifies acute fractures based on patterns of bone marrow edema that are visible for 6–12 weeks after injury.¹⁹ It also differentiates benign osteoporotic fractures from pathological fractures caused by cancer.²⁰ DEXA Test (Bone Density) T-scores between -1.0 and -2.5 indicate osteopenia (low bone mass). T-scores below -2.5 indicate osteoporosis. Each decrease in bone density by one standard deviation approximately doubles the risk of fracture.^21,22

What Imaging Best Shows Vertebral Fractures?

MRI has been shown to be superior for detecting acute fractures, determining the age of a fracture, and identifying pathological fractures, thanks to its ability to visualize soft tissues—something that is not possible with X-rays or CT scans.²³

How are Fractures Classified for Treatment?

The TLICS (Thoracolumbar Injury Classification and Severity) system assesses the fracture pattern, ligament integrity, and neurological status. Scores below 4 typically warrant conservative management, while scores above 4 indicate a potential benefit from surgery.²⁴

How Does Physiotherapy Help in Recovering from Vertebral Fractures?

Physical therapy focuses on a gradual recovery rather than a fixed timeline. Prolonged rest is not recommended: it is important to stay active, overcome the fear of moving, and gradually resume your activities. The pace is determined in consultation with the treatment team. This includes safe exercises, education on body mechanics, and strategies to prevent falls.

To learn more about how physiotherapy effectively treats back pain, please visit our page on services for the back region.

Rehabilitation proceeds in stages, with no set timeline. We begin by managing pain and ensuring proper posture, then gradually resume movement, followed by strengthening exercises. The strengthening exercises focus primarily on the back extensor muscles and the muscles that stabilize the spine and core.

Strengthening the back extensor muscles isn't just about recovery. People who follow a program to strengthen their back extensors are less likely to suffer another vertebral fracture later on.

Fall prevention programs reduce fall rates by about 25% among older adults.²⁹

You are not alone in this journey. Our physiotherapists will support you every step of the way, adjusting exercises to your comfort level.

What is the Healing Time for Vertebral Fractures?

Vertebral fractures typically heal within 12–16 weeks. Acute pain decreases significantly after 4–6 weeks. Bone healing involves inflammatory, reparative, and remodeling phases over a period of 3–12 months.^30,31

Pain Trajectory Severe acute pain is most pronounced during the first 2–4 weeks, then gradually subsides. Most patients experience a substantial reduction in pain by 6–8 weeks.³² Approximately 30% of patients report persistent pain beyond 12 months.³³ Fracture Cascade Risk Patients with a vertebral fracture face an approximately 5-fold increased risk of additional vertebral fractures and a 2-fold increased risk of hip fractures.³⁴ Having previously suffered an osteoporosis-related fracture greatly increases the risk of having another one. The risk of another vertebral fracture is then 5.4 times higher, and the risk of a hip fracture is 2.8 times higher.

Everyone heals at their own pace. If your recovery takes longer than expected, don't get discouraged. Your physiotherapist will adjust your program based on your individual progress.

What Exercises are Safe After a Vertebral Fracture?

Safe exercises include walking with good posture, isometric core strengthening, spinal extension exercises, and balance training. Initially, avoid bending forward and twisting under load.

Walking One of the safest and most beneficial exercises for young children is to maintain good posture and avoid leaning forward.³⁵ Start with short walks and gradually increase the duration based on your pain tolerance and your physical therapist’s advice. Walking helps maintain bone density, but it’s not enough on its own: strength training, using weights or resistance bands, is also necessary. Isometric Exercises Muscle contraction without joint movement is also safe during the acute phases. Abdominal bracing (gentle contraction of the transverse abdominis muscle) and gluteal contractions are particularly recommended.³⁶ Perform holds for 5-10 seconds, repeat 10 times. Extension Exercises Placing the patient in the prone position (face down) for 10–15 minutes daily provides gentle passive extension.³⁷ Active exercises include prone lifts (cobra pose), wall angels, and chin tucks. Sinaki’s SPEED program strengthens the spinal extensor muscles. In women with osteoporosis and a hunched posture, it has reduced the risk of falls and back pain. Progressive Resistance Training Begins approximately 8–12 weeks after the fracture.³⁸ Progress from bodyweight exercises using resistance bands to light free weights. You should also avoid forward bending while under load, twisting while under load, and high-impact activities. Balance Training The program also includes single-leg standing, tandem walking (heel-to-toe), weight-shifting exercises, and gentle tai chi movements.³⁹ Start with a stable support (hold onto the counter), then progress to challenges without support. Combining balance training with progressive strength training yields better results than either one alone in terms of leg strength, balance, bone density, and physical function.

How to Prevent Future Vertebral Fractures?

Prevention involves a combination of osteoporosis treatment, calcium supplementation (1,200 mg) and vitamin D supplementation (800–1,000 IU), regular weight-bearing exercise, and strategies to prevent falls.⁴⁰

Osteoporosis Medications Bisphosphonates (alendronate, risedronate) reduce the risk of vertebral fractures by 50–70%.⁴⁰ Anabolic agents (teriparatide, romosozumab) show an even greater reduction of 65-85% in severe cases.⁴¹ Treating osteoporosis with medication reduces the risk of fracture. Such treatment can lower the risk of fracture in the following year by 50 to 80 percent. Exercise for Bone Health Weight-bearing activities (walking, climbing stairs, dancing) stimulate bone formation.⁴² Resistance training 2-3 times per week with moderate to high intensity improves bone density.⁴³ Fall prevention Home safety assessments eliminate hazards (loose rugs, poor lighting). Correcting vision and reviewing medications also reduce the risk of falls.⁴⁴

Strategy	Recommendations
Medications	Bisphosphonates (alendronate, risedronate), denosumab, anabolic agents (teriparatide)
Supplements	Calcium 1200mg/day, vitamin D 800-1000 IU/day, magnesium
Exercise	Daily weight-bearing activities (walking, stairs), strength training 2-3 times/week
Fall prevention	Home safety, vision correction, medication review, balance exercises
Lifestyle	Smoking cessation, limit alcohol, maintain healthy weight, adequate protein intake

When are Procedures like Vertebroplasty Considered?

Vertebroplasty is considered for painful fractures that do not respond to 4–6 weeks of conservative treatment. This bone cement injection offers potential relief, but controlled studies show mixed results.⁴⁷

Vertebroplasty Percutaneous injection of bone cement (PMMA) into the fractured vertebral body under fluoroscopic guidance to stabilize the fracture.⁴⁵ Kyphoplasty Adds an initial step of inflating a balloon inside the vertebral body in an attempt to restore height before injecting cement.⁴⁶ Effectiveness Initial studies suggested dramatic relief in 75–90% of patients.⁴⁸ However, two placebo-controlled trials published in 2009 showed no significant benefit compared to a sham procedure.⁴⁹ Subsequent studies suggest modest benefits in carefully selected patients.⁵⁰

The decision requires an individualized assessment, weighing potential benefits against risks, considering pain severity, fracture characteristics, and response to conservative treatment.

What are the Long-Term Effects of Vertebral Fractures?

Long-term effects include chronic pain (30% of patients after one year), progressive deformity with kyphosis and loss of height, reduced lung function, and a fivefold increased risk of future vertebral fractures.^51,54

Chronic pain Pain persists beyond the expected recovery time in about 30% of patients. Management approaches include ongoing exercise, postural training, and manual therapy.⁵¹ Spinal Deformity Progressive thoracic kyphosis shifts the center of gravity forward, requiring compensatory postural adjustments and increased muscular effort.⁵² Reduced lung capacity Each thoracic vertebral fracture reduces vital capacity by about 9%.⁵³ Fracture cascade Patients face an approximately 5-fold increased risk of subsequent vertebral fractures and a 2-fold increased risk of hip fractures. The period of highest risk occurs within the first year following the initial fracture, underscoring the importance of immediate, aggressive treatment of osteoporosis.^54,55

Patients receiving coordinated multidisciplinary care (medical treatment, physical therapy, nutritional optimization) demonstrate superior outcomes.⁵⁶

Ready to Recover from Your Vertebral Fracture?

Our physiotherapists at Physioactif provide specialized rehabilitation for vertebral fractures. We combine safe, progressive exercises tailored to each healing phase, pain management strategies, and education on fracture prevention.

Our team helps you regain function, prevent future fractures through evidence-based training for bone health and balance, and maintain your independence with individualized treatment protocols.

The rehabilitation process requires patience, as bone healing takes several months. Consistent participation in properly designed exercise programs yields significant benefits in terms of pain reduction, functional restoration, and the prevention of future fractures.

Contact Physioactif today to schedule your assessment and begin your structured rehabilitation program.

References

1. Ballane G, et al. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int. 2017;28(5):1531-1542.
2. Hulme PA, et al. Vertebroplasty and kyphoplasty: a systematic review. Spine. 2006;31(17):1983-2001.
3. Wood KB, et al. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-164.
4. Johnell O, Kanis JA. Worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733.
5. Cosman F, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381.
6. Duan Y, et al. Biomechanical basis of vertebral body fragility. J Bone Miner Res. 2001;16(12):2276-2283.
7. Denis F. Three column spine and its significance in thoracolumbar injuries. Spine. 1983;8(8):817-831.
8. Coleman RE. Metastatic bone disease: clinical features and treatment strategies. Cancer Treat Rev. 2001;27(3):165-176.
9. Schlenz RJ, et al. Spondylolysis in the athlete. Clin Sports Med. 1993;12(3):517-528.
10. Kim DH, Vaccaro AR. Osteoporotic compression fractures: current options. Spine J. 2006;6(5):479-487.
11. Lindsay R, et al. Risk of new vertebral fracture following a fracture. JAMA. 2001;285(3):320-323.
12. Pongchaiyakul C, et al. Asymptomatic vertebral deformity as risk factor. J Bone Miner Res. 2005;20(8):1349-1355.
13. Kado DM, et al. Vertebral fractures and mortality in older women. Arch Intern Med. 1999;159(11):1215-1220.
14. Leech JA, et al. Lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141(1):68-71.
15. Denis F, et al. Acute thoracolumbar burst fractures without neurologic deficit. Clin Orthop Relat Res. 1984;(189):142-149.
16. Gehlbach SH, et al. Recognition of vertebral fracture in clinical setting. Osteoporos Int. 2000;11(7):577-582.
17. Genant HK, et al. Vertebral fracture assessment using semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148.
18. Eastell R, et al. Classification of vertebral fractures. J Bone Miner Res. 1991;6(3):207-215.
19. Baur A, et al. Diffusion-weighted MR imaging of bone marrow. Radiology. 1998;207(2):349-356.
20. Cuenod CA, et al. Acute vertebral collapse due to osteoporosis or malignancy. Radiology. 1996;199(2):541-549.
21. Kanis JA, et al. Diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137-1141.
22. Marshall D, et al. Meta-analysis of bone mineral density predict osteoporotic fractures. BMJ. 1996;312(7041):1254-1259.
23. Jung HS, et al. Discrimination of metastatic from acute osteoporotic compression fractures with MR imaging. Radiographics. 2003;23(1):179-187.
24. Vaccaro AR, et al. New classification of thoracolumbar injuries. Spine. 2005;30(20):2325-2333.
25. Sinaki M, et al. Reducing risk of falls through proprioceptive dynamic posture training. Am J Phys Med Rehabil. 2002;81(4):241-246.
26. Papaioannou A, et al. Recommendations for preventing fracture in long-term care. CMAJ. 2015;187(15):1135-1144.
27. Bonaiuti D, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2002;(3):CD000333.
28. Hongo M, et al. Effect of low-intensity back exercise on quality of life. Mayo Clin Proc. 2007;82(12):1477-1486.
29. Sherrington C, et al. Exercise for preventing falls in older people living in community. Cochrane Database Syst Rev. 2019;1(1):CD012424.
30. McKee MD, et al. Effect of smoking on clinical outcome following Ilizarov reconstruction. J Orthop Trauma. 2003;17(10):663-667.
31. Johnell O, et al. Acute and long-term increase in fracture risk after hospitalization. Osteoporos Int. 2001;12(3):207-214.
32. Ong T, et al. Characteristics and outcomes of hospitalised patients with vertebral fragility fractures. Age Ageing. 2018;47(1):17-25.
33. Silverman SL, et al. Health-related quality of life to prevalent and incident vertebral fractures. Arthritis Rheum. 2001;44(11):2611-2619.
34. Klotzbuecher CM, et al. Patients with prior fractures have increased risk of future fractures. J Bone Miner Res. 2000;15(4):721-739.
35. Giangregorio LM, et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis. Osteoporos Int. 2014;25(3):821-835.
36. Richardson CA, et al. Relation between transversus abdominis muscles and low back pain. Spine. 2002;27(4):399-405.
37. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-596.
38. Hourigan SR, et al. Positive effects of exercise on falls and fracture risk in osteopenic women. Osteoporos Int. 2008;19(7):1077-1086.
39. Sherrington C, et al. Effective exercise for prevention of falls: systematic review and meta-analysis. J Am Geriatr Soc. 2008;56(12):2234-2243.
40. Black DM, et al. Randomised trial of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348(9041):1535-1541.
41. Saag KG, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377(15):1417-1427.
42. Kelley GA, et al. Exercise and bone mineral density in men: meta-analysis. J Appl Physiol. 2000;88(5):1730-1736.
43. Martyn-St James M, Carroll S. Meta-analysis of impact exercise on postmenopausal bone loss. Int J Sports Med. 2009;30(12):864-870.
44. Gillespie LD, et al. Interventions for preventing falls in older people living in community. Cochrane Database Syst Rev. 2012;9:CD007146.
45. Galibert P, et al. Treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166-168.
46. Garfin SR, et al. Kyphoplasty and vertebroplasty for treatment of painful osteoporotic compression fractures. Spine. 2001;26(14):1511-1515.
47. Voormolen MH, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment. J Vasc Interv Radiol. 2007;18(6):737-744.
48. Kallmes DF, et al. Randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569-579.
49. Buchbinder R, et al. Randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568.
50. Blasco J, et al. Effect of vertebroplasty on pain relief, quality of life, and incidence of new vertebral fractures. J Bone Joint Surg Am. 2012;94(12):1055-1061.
51. Gold DT. Clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone. 1996;18(3 Suppl):185S-189S.
52. Kado DM, et al. Hyperkyphotic posture predicts mortality in older community-dwelling men and women. J Am Geriatr Soc. 2004;52(10):1662-1667.
53. Schlaich C, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998;8(3):261-267.
54. Ross PD, et al. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919-923.
55. Lindsay R, et al. Risk of new vertebral fracture in year following a fracture. JAMA. 2001;285(3):320-323.
56. Sale JE, et al. Secondary prevention after an osteoporosis-related fracture. Can J Surg. 2001;44(4):259-267.