Vertebral Compression Fractures represent an area of changing understanding of Osteoporosis. As an orthopaedic surgeon, I understand that a fracture is a fracture whether it occurs all at once or gradually over time. This understanding is spreading in the Osteoporosis community.
Vertebral Compression Fractures gradually cause the hunched over back in a person with osteoporosis. This is the accumulation of thousands of microfractures which heal slightly crunched down over many years. The gradual crunching down is usually so slow that over 80% of patients do not realize that their back has crunched. Now we can prevent this!
When an older person loses height, it is usually crunched vertebra, not just poor posture. Are you Shrinking? You should have a VFA test or a lateral spine x-rays specifically looking for Vertebral Compression Fractures. A single crunch of 25% or more (Genant Grade 2) defines Osteoporosis regardless of DXA and BMD.
Vertebral Compression Fractures indicate a marked increase in Risk of Future Fracture. A person with one Vertebral Compression Fracture is 5 times as likely to have another. A person with one Vertebral Compression Fracture is more than 2 times as likely to have a hip fracture. Multiple Vertebral Compression Fractures increase the Risk of Future Fracture even more.
A Vertebral Compression Fracture is, by definition, Osteoporosis. Current FRAX guidelines for treatment of Osteoporosis recommend pharmacological treatment of any individual with a Vertebral Compression Fracture because of the increased Risk of Future Fracture.
Jay Ginther, MD
2008 / Revised November 2010