What is typical for an elderly person suffering vertebral compression fractures

Q: My 88-year-old mother just suffered her first vertebral compression fracture. We are new to all this so we looked at your Patient Guide to Spinal Compression Fractures. But we have a few more questions. Mom’s fracture is at the T5 level. The surgeon mentioned this was “unusual.” What is more typical? Does it matter what level is affected?

A: From your reading you now know that compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height.

Compression fractures are most common in older adults as a result of osteoporosis (decreased bone density causing brittle bones). About 700,000 cases of compression fractures due to osteoporosis occur each year in the United States. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.

Research shows that the distribution of osteoporotic vertebral compression fractures varies. The most common vertebra affected is at the bottom of the thoracic spine where the lumbar spine begins (T12 and L1). But fractures occur anywhere from T5 to L5.

According to a recent study of 177 osteoporotic vertebral compression fractures (in 89 adults), the distribution follows a bell-shaped curve. There were five fractures at T5, 10 fractures each at T6 and T7. The number increased slightly to around 14 between T8 and 11. Then the largest number were at T12 (26 of the 177 fractures located here). At the L1 to L3 levels, there were between 20 and 26 fractures. The numbers gradually declined from 15 fractures at L3 to 11 at L4 and five at L5.

So you can see that a fracture at T5 (upper end of the thoracic spine) is less common than most other locations. The mechanism of injury (e.g., fall, twist, cough) and force placed on the bone may determine where the fracture develops. For example, a fall on the buttocks is more likely to fracture the lumbar spine than the upper thoracic vertebrae.

The person’s posture is also important. Older adults who are bent forward with their spine curved in kyphosis (forward curve) have very different load and force placed on the vertebral bodies when compared with upright posture. Likewise, a fall that results in the person hitting the back of the head and/or upper back could cause fractures higher up in the spine.

Whether it is “better” or “worse” to have a fracture at one level over another is not something that has been researched. The real factors that seem to make the most difference are the patient’s age, severity of fracture, type of fracture, and overall general health. The presence of other health care problems called comorbidities can slow down the healing process more than anything else.

Reference: Marc J. Nieuwenhuijse, MD, et al. Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Identification of Risk Factors. In The Spine Journal. September 2011. Vol. 11. No. 9. Pp. 839-848.