What it is
An osteoporotic vertebral compression fracture is a wedge or crush injury of a spinal vertebra that occurs with low-energy load in the setting of reduced bone strength. It is most common at the thoracic and thoracolumbar junction. Pain is sudden after a minor movement, lift, or cough, and worsens with standing or walking.
Care requires prompt medical assessment for pain control, exclusion of more serious causes, and a coordinated rehabilitation plan. Focus areas include safe mobility, gradual extension-based strength, balance, and fall prevention. Bone health management sits alongside rehabilitation.
What happens when it occurs
The vertebral body partially collapses, creating a wedge-shaped deformity. Muscles guard and posture become flexed. Early protection, analgesia, and activity modification reduce pain. Bracing is used in selected cases. Extension and posterior chain strengthening improve posture and tolerance in stages.
Common causes and risk factors
- Osteoporosis and low bone mineral density
- Older age and family history
- Long-term corticosteroid use and low vitamin D
- Low physical activity and prior fragility fractures
Who is most affected
Older adults in Australia are affected more often by this condition, with women being affected more frequently than men. Men with risk factors are also present.
Typical symptoms
- Sudden mid-back pain after a small movement, lift, or cough
- Pain is worse with standing and walking, eased by supported sitting
- New rounding of the back or loss of height over time
When to seek care
Immediately for new severe back pain in older adults, after a fall, or if there is fever, neurological change, or bowel or bladder symptoms.
How we diagnose
History and examination with a neurological screen, X-rays to confirm a wedge or crush change, and MRI or CT scans when the diagnosis is unclear or to assess acuity. Bone health review is standard.
Management
- Analgesia plan and activity modification
- Short-term bracing in selected cases when advised
- Early safe mobility, breathing drills, and circulation exercises
- Extension-based back extensor strength, hip and leg strength, and balance training
- Education on spine-sparing strategies for daily tasks
- Bone health plan with GP or specialist, including calcium, vitamin D, and medication when appropriate
Rehabilitation milestones
Phase 1 weeks 0 to 2: pain control, protected mobility, posture support, walking in short bouts.
Phase 2 weeks 2 to 8: progressive extension strength, hip and leg work, balance drills, longer walks.
Phase 3 months 2 to 6: endurance for community tasks, return to hobbies, and falls risk reduction.
Readiness to progress
- Pain is controlled at rest and with short walks
- Improving posture with extension strength
- Balance and walking distance targets achieved
Long-term care
- Back extensor strength twice weekly
- Daily walking and balance work
- Bone health monitoring and home falls prevention
Australia snapshot
- Common in older Australians, particularly women
- Most recover meaningful function with coordinated medical and rehabilitation care.
- Bone health assessment and falls prevention reduce the chance of further fractures.
Latest insights
Treat the fracture and the bone disease. Both matter for long-term results.
Extension strength and balance are the engines of recovery.
