Osteoporosis – the Facts Behind Spinal Fractures and Back Pain

By Sarah Leyland, Clinic Adviser, Royal Osteoporosis Society (originally printed in TalkBack, Autumn 2021)

Back pain caused by spinal fractures

Osteoporosis itself doesn’t cause back pain or any other symptoms unless you actually fracture a bone. While most fractures happen after a fall, spinal fractures can happen  without an accident or fall. Bones in the back squash down and become flattened or wedge shaped – sadly, then staying in this changed shape even after healing has taken place.
Osteoporotic spinal fractures are called “stable” fractures, which means they don’t affect the spinal cord and cause paralysis – a common concern of people when they are first diagnosed with a spinal fracture. Spinal fractures affect people in different ways. Some people get no pain and are not affected by the fracture, while other people get severe  back pain when a fracture occurs. The pain normally improves gradually, but some people experience long-term, persistent pain as the shape of the spine changes. People  experiencing a number of spinal fractures can also suffer height loss as a result of curvature of the spine and might also begin to experience long-term back pain as muscles  and ligaments try to adapt to this changed spinal shape. Nerves can also become irritated by changes in the spine.
Curvature of the spine can also have other physical effects such as causing difficulty breathing and mobility issues. There can also be an emotional impact as people’s body image or self-esteem are affected.

Preventing osteoporosis and spinal fractures

A healthy lifestyle can help to build, maintain and promote bone strength – even if you already have osteoporosis, it’s still important. Top tips for a healthy lifestyle for bones:

  • Aim for a well-balanced, mixed diet with plenty of protein and calcium. Adults need 700 mg of calcium a day. If you’re taking an osteoporosis medication, you may benefit from increasing your daily calcium intake to around 1,000 mg or you may be getting enough from your diet. Talk to your healthcare professional about what is  right for you.
  • Make sure you get enough vitamin D. This can be through sensible exposure to the sun during the summer months when the sun’s rays stimulate the skin to produce vitamin D – about 10 minutes twice a day with bare face and arms, but not enough to get burnt. Alternatively, you can take a 10 microgram daily supplement if you cover  up completely. Everyone should consider taking a supplement from the end of September to the end of March anyway because you can’t get enough vitamin D from the  sun’s rays during that time.
  • Maintain a healthy body weight – not under or overweight.
  • Exercise needs to include weight-bearing exercise with impact (involves being on your feet and adding an additional force or jolt through your skeleton – anything from walking to star jumps), as well as muscle strengthening exercise.
  • Don’t smoke or consume excessive alcohol (above recommended limits).

People living with osteoporosis often worry about exercise or everyday activities causing a spinal fracture. However, for most people, moving, lifting, bending and impact exercises like jogging are not going to cause a fracture. The Royal Osteoporosis Society (ROS) has lots of information about caring for your back and sensible ways to approach activities by building up exercise gradually to make sure you don’t injure yourself. Muscles and bones need to be used and exercise is really important to improve the strength of both.

The ROS also has information about specific exercises to reduce the risk of falling over as we get older by improving our balance and muscle strength. These exercises can be  easily integrated into daily activities like standing on one leg with support if needed, sit to stand exercises and heel raises. See the ROS factsheet and video on “Exercise to  improve balance and muscle strength” for more ideas, and to learn how to do these exercises safely.

Treatments for spinal fractures

The good news is that many spinal fractures usually heal on their own in about six to 12 weeks. There is no need to keep still or wear a brace – in fact, regular movement and certain types of exercise are encouraged. However, where there is pain it can be helped by pain-relieving drugs, or practical measures such as using a TENS machine, gentle  massage, relaxation and breathing exercises. Other approaches might be considered such as complementary therapies, psychological help, physiotherapy, hydrotherapy, pain clinics, pain management courses or self-management groups. There is also a surgical procedure which is sometimes used to help with pain that doesn’t resolve. The procedure is called percutaneous vertebroplasty or kyphoplasty, which is when a cement is injected into the spinal bones. However, this isn’t available at all hospitals and there is some dispute among experts as to whether it works or not. Specific exercises can also help with back pain after spinal fractures. Gentle stretching exercises are useful and, in the longer term, increasing muscle strength around the spine can support it and reduce the spasm caused as muscles adapt to the changed spinal shape. The ROS has videos and fact sheets to explain more about these exercises.

Diagnosing a spinal fracture

An x-ray is the best way to find out if someone has a spinal fracture caused by osteoporosis. A GP will refer someone if they have specific symptoms such as getting shorter, back pain or curvature of the spine. If someone has broken other bones, for example a wrist or hip, then that too might be a sign that someone is at risk of spinal fractures.
A spinal fracture that was not caused by any other medical condition or as the result of a traumatic accident could be symptomatic of osteoporosis. A bone density (DEXA) scan can be used to diagnose osteoporosis, highlighting that bones are less dense than the average adult. Research has shown that the lower the bone density, the greater the risk of fracture.

Drug treatments for osteoporosis

While receiving a diagnosis of osteoporosis can be a shock, the good news is that there are a number of drug treatments available to strengthen bones and reduce the chance of having a fracture. The drug that is usually prescribed first is a weekly tablet called alendronic acid which belongs to a family of drugs called bisphosphonates. It is generally given to older men and post-menopausal women who are deemed to have a high risk of fracture.

This is calculated by assessing all the including bone density and whether other bones have been broken already. There are other medications available too and the decision about which treatment is right for the patient will depend on someone’s own individual circumstances. When people are diagnosed with spinal fractures, they typically have  any questions about what this means for them. ROS has created a series of new videos to help answer some of the most common questions. Developed by people who are living with osteoporosis and spinal fractures, and bone health experts, the new videos can be found at: