Also called: Vertebral fracture; osteoporotic compression fracture
Exercise strongly helps
Strength
A vertebra collapsing under low load because bone density is low. Two thirds happen with no recognised event, and each one substantially raises the risk of the next - which makes finding the first one the single most valuable thing.
How common: Around 25% of postmenopausal women have at least one; two-thirds are never diagnosed
What it is
In osteoporosis a vertebral body can fracture under loads as ordinary as bending, lifting a shopping bag, or a heavy sneeze. The front of the vertebra wedges, which produces height loss and increases the forward curve of the upper back.
The critical fact is what it predicts. A vertebral fracture roughly quintuples the risk of another one within a year and doubles the risk of a hip fracture. Yet around two thirds are never diagnosed, because the pain is attributed to ordinary back pain and no imaging is done - which means the treatment that could prevent the next one is never started.
What it feels like
- Sudden back pain, sometimes with a trivial movement or with none at all
- Pain worse on standing and walking, better lying down
- A band of pain around the level of the fracture
- Height loss, sometimes several centimetres over years
- An increasing forward curve of the upper back
- Or, in many cases, nothing at all - found incidentally on a scan
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Low bone density
- The vertebral body is mostly trabecular bone, which is the type lost fastest in osteoporosis. It reaches a point where ordinary loads exceed its strength.
- Bending and lifting
- Forward flexion concentrates load on the front of the vertebral body. This is the commonest mechanism, and it is why loaded spinal flexion is specifically cautioned against in osteoporosis.
- Postmenopausal oestrogen loss
- Bone loss accelerates sharply after menopause, and vertebral fractures are the most common osteoporotic fracture in the years that follow.
- Long-term corticosteroids
- Steroids cause rapid bone loss, particularly in trabecular bone, and vertebral fractures are the characteristic consequence. Risk rises within months of starting.
- A previous vertebral fracture
- The strongest single predictor of the next one. The altered mechanics of a wedged spine increase load on the vertebrae above and below it.
- Age
- Bone density falls and fracture risk rises steeply with age in both sexes. Men are affected too and are considerably under-diagnosed.
- Low body weight and undernutrition
- Low body weight is a well-established fracture risk factor, and inadequate protein, calcium and vitamin D all reduce bone quality.
- Falls
- Even a fall from standing height can fracture an osteoporotic vertebra, and falls become more likely with the balance and strength decline that often accompanies it.
- Cancer - the important alternative
- Metastatic disease and myeloma both cause vertebral collapse. New back pain in someone with a cancer history, or with weight loss and night pain, needs investigation rather than assumption.
Who tends to get it
- Postmenopausal women, particularly with other osteoporosis risk factors
- Anyone on long-term or repeated corticosteroids
- People who have already had a vertebral or other low-trauma fracture
- Anyone with height loss or an increasing curve of the upper back
- Men over seventy, who are frequently overlooked
What makes it worse, and what settles it
Makes it worse
- Loaded forward bending and twisting, which is the mechanism itself
- Sit-ups, toe-touching and any exercise loading the spine in flexion
- Prolonged bed rest, which accelerates further bone loss
- Ignoring the diagnosis, since it is the single strongest predictor of the next fracture
- Not starting bone treatment, which is the main thing that changes what happens next
Settles it
- Getting properly diagnosed and treated for osteoporosis - the fracture is the alarm and treatment is the response
- Back extensor strengthening, which reduces further fracture risk and improves posture
- Balance training, because preventing falls prevents fractures
- Weight-bearing and resistance exercise, avoiding loaded spinal flexion
- Adequate calcium, vitamin D and protein, checked rather than assumed
What actually helps
The short version: A vertebral body collapses under low load because bone density is low; it drives the stooped posture and further fracture risk
Strength work: Back: Spinal Erectors - prone and standing extension work; Glutes: Max; Core: Transverse Abdominis; progressive weight-bearing
Stretching: AVOID all loaded spinal flexion and twisting; Chest; Hips: Flexors instead
Massage: Back: Upper Back - light, never over the fracture site
Also worth doing: Balance and fall prevention; bone medication; posture support
What the evidence says: Extension-based strengthening reduces further fracture risk. Loaded flexion (sit-ups, crunches, toe touches) significantly increases it - this is one of the few genuine exercise contraindications.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineStrength & Bone for Aging
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Sudden severe back pain in anyone over 50 with osteoporosis risk needs imaging before any exercise; height loss over 4 cm is a marker
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Acute pain from a compression fracture usually settles over six to twelve weeks as the bone heals, though the height loss and the curve are permanent. What matters far more is what happens next: with a diagnosed vertebral fracture, osteoporosis treatment substantially reduces the risk of further fractures, and exercise supports it. Sudden severe back pain in an older adult should be imaged rather than assumed to be muscular - the fracture that is found is the one that can be acted on.
Prevalence basis: Vertebral morphometry studies
Others the same routine covers
These share the Strength & Bone for Aging routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.