Our bones are a complex structure with a protein framework and mineral deposited within this to provide rigidity and strength. Osteoporosis is a condition where the mineral content of the bone changes. This causes weakness in the bones, so they fracture easily. Back pain from osteoporosis is most commonly related to compression fractures of the vertebra. The bones of the thoracic and lumbar spine are often affected and can become compressed.
Spinal compression fractures that occur as a result of osteoporosis are actually quite common. In many cases they are small and are often not diagnosed, and contribute to the loss of height that many older people notice. They may cause pain that is often just thought of as general back pain, such as from a muscle strain or other soft tissue injury, or as a common part of ageing.
In some cases, though, osteoporotic fractures can cause severe pain which may continue for some months. This may sometimes lead to chronic pain, deformity (thoracic kyphosis, commonly referred to as a dowager's hump), loss of height and progressive weakness and unfitness to lack of activities and exercise.
Although compression fractures from osteoporosis are commoner in the elderly, they can also occur in people as young as 40 or 50 years old.
Spinal fractures due to osteoporosis often occur while doing something that causes relatively minor trauma to the spine, such as opening a window, an insignificant fall, or twisting while lifting. Advanced cases of osteoporosis can even lead to a vertebral fracture with routine activities that would normally not cause any trauma, such as sneezing, coughing or turning over in bed.
Because of the way that weight is transmitted through the spine, a compression fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged. This results in a wedge shaped vertebra and it is sometimes called a "wedge fracture". Because the majority of damage is limited to the front of the vertebral column, the fracture is usually stable and rarely associated with any nerve or spinal cord damage.
The pain from a vertebral compression fracture may be very substantial, and often lasts for some months while slowly settling. Sometimes the pain from the fracture, or the change in the mechanics of the spine that result, can become persistent.
Injections and other invasive treatments have limited value in treating vertebral compression pain, and the mainstay of treatment is painkillers and sometimes approaches such as TENS. In a few cases a procedure to try to strengthen or re-expand the vertebral body can be appropriate - this is a surgical operation called a kyphoplasty or vertebroplasty. These procedures are discussed further at this linked page.
Osteoporosis is particularly common in post-menopausal women and can be influenced by stopping smoking, diet, calcium and vitamin D supplements, and keeping going with physical activity.
General information on osteoporosis can be found at the patient.co.uk site or the National Osteoporosis Society site.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 15/02/2016