Vertebral Compression Fractures — Kyphoplasty & Bone Health

The Basics

What Is a Vertebral Compression Fracture?

A break in which the front of a spinal bone collapses, most often because the bone has been weakened by osteoporosis. It is one of the most common fractures in older adults.

Each vertebra has a block-shaped front portion, the vertebral body, that carries most of your weight. When the bone inside becomes thin and porous from osteoporosis, that block can crack and collapse under everyday loads — bending, lifting a bag of groceries, or even a hard cough. Because the front of the body usually gives way first, it collapses into a wedge shape, which tips the spine a little further forward with each fracture.

The classic story is sudden, sharp back pain at a specific spot that is much worse with standing, walking, or changing position and better lying flat. Some fractures, though, cause surprisingly little pain and are found by chance on an X-ray. Unlike a herniated disc, a compression fracture usually does not pinch a nerve, so pain that travels down a leg, or new numbness or weakness, is a signal to look for a different or more serious problem.

Most compression fractures heal on their own over six to twelve weeks. The two questions that matter most are: does this painful fracture need a procedure to settle it, and — just as important — why did the bone break, and how do we prevent the next one? Both are covered on this page.

At a Glance

Most common cause: osteoporosis (weak bone)

Hallmark: sudden back pain, worse standing

Common shape: wedge (front collapses)

Usual healing: 6–12 weeks, often non-surgical

Procedure option: vertebroplasty or kyphoplasty

Just as important: treat the bone to prevent the next one

Weak Bone Collapses

Osteoporosis thins the vertebral body until it cracks under ordinary loads, sometimes with no real injury.

Sudden, Local Pain

A sharp pain at one spot that worsens with standing or moving and eases lying down is the classic sign.

Often Heals Itself

Most fractures settle over 6 to 12 weeks with pain control and gentle activity, no procedure required.

A Warning Sign

One fragility fracture sharply raises the odds of another, so treating the underlying bone is essential.

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When a fracture needs urgent attention

A compression fracture usually does not affect the nerves. Seek prompt evaluation for new leg numbness or weakness, loss of bladder or bowel control, fever, unexplained weight loss, or a fracture after high-energy trauma. These can point to a burst fracture pressing on the spinal canal, or to a fracture caused by infection or a tumor rather than osteoporosis — situations that are managed very differently.

Symptom Response

Which Symptoms Does Treatment Help?

Cement augmentation is very good at the mechanical pain of a fresh fracture and less useful for old pain or established deformity. Select a symptom to see what to realistically expect.

Select a symptom to see how treatment typically affects it.

Interactive Tool

See How the Repair Works

Pick a fracture pattern, then step through a vertebroplasty or a balloon kyphoplasty to see how bone cement stabilizes the vertebra — and why only kyphoplasty can restore some lost height. This is educational, not a diagnosis.

Fracture pattern

Procedure

Step through it

Vertebral boneBone cementBalloonNeedleFracture / at-risk

Patient Selection

Am I a Candidate?

Whether a procedure helps depends on the fracture, its pattern, your bone health, and your general health. Choose a category, then select a factor to learn more.

Select a factor to see how it affects candidacy and which treatment fits.

Treatment Options

From Bracing to Surgery

Most fresh fractures are managed without a procedure. Cement augmentation is considered for pain that is not settling, and fixation is reserved for unstable fractures. Alongside all of these, the underlying bone is treated.

First · Non-Surgical Care

Time, Pain Control, and a Brace

Most osteoporotic compression fractures heal on their own over six to twelve weeks. Short-term pain medication, a brace for comfort, and staying gently active while avoiding prolonged bed rest allow the bone to knit. At the same time, we start looking into why the bone broke.

When Needed · Procedures

Stabilize the Bone

When pain is severe or not improving with a fair trial of non-surgical care, injecting bone cement (vertebroplasty or kyphoplasty) can splint the fracture and relieve pain. Unstable or burst fractures, or those threatening the nerves, instead need screws and rods.

The Main Options

Select an option to see how it works and when it is chosen. At Brown we favor the least-invasive effective treatment and reserve bigger operations for genuine instability.

How is an unstable fracture stabilized?

When a fracture needs more than cement, screws and rods stabilize the spine while it heals. See how those screws are placed through small incisions, using robotic navigation.

The Procedure

How Balloon Kyphoplasty Works, Step by Step

This walks through a typical balloon kyphoplasty — lifting the collapsed bone and filling it with cement. Select an option above to switch pathways, and select each step to learn what happens and why.

Select a step to learn what happens, and why.

Results

What Outcomes Can Patients Expect?

For the right fracture, cement augmentation is one of the more gratifying procedures in spine care. Results vary, and honest expectations matter.

1–2 days

Typical Pain Relief

Well-selected patients often feel meaningful relief of mechanical pain within a day or two of augmentation.

6–12 wks

Heal Without Surgery

Many fractures settle with bracing, pain control, and time alone, with no procedure ever needed.

~5×

Risk of the Next One

A first fragility fracture sharply raises the risk of another, which is why treating the bone is essential.

Risks and Honest Trade-offs

Cement augmentation is generally low-risk, but no procedure is risk-free. The main specific concern is cement leaking outside the vertebra; usually this causes no problem, but rarely it can irritate a nerve or, very uncommonly, travel in the bloodstream. Other risks include infection, bleeding, and, importantly, a new fracture at a neighboring level — the bone next to a treated vertebra remains osteoporotic and still carries load. This is one more reason that treating the underlying bone is not optional.

It is also worth being clear about benefit: augmentation reliably targets mechanical fracture pain, but it does not treat pain from arthritis, muscle strain, or old healed fractures, and it does not reverse a stooped posture that has already set in. Careful selection — the right fracture, the right pain pattern, confirmed on imaging — is what separates a gratifying result from a disappointing one.

Prevent the Next One

Bone Health Is Half the Treatment

A compression fracture is often the first visible sign of osteoporosis. Fixing the fracture without treating the bone leaves the real problem in place — and if a fusion is ever needed, the strength of that bone is what the hardware has to hold onto.

Doctors call a fracture that happens from a minor force a fragility fracture, and it is a sentinel event: it tells us the bone is weak enough to break again. The risk of a second fracture is highest in the first year, and each new fracture makes the next one more likely and the spine a little more stooped. That cascade is preventable, and breaking it is as important as treating the fracture that brought you in.

For that reason, part of caring for a compression fracture is a bone-health work-up and, in most cases, medication to rebuild bone strength. This is usually coordinated with your primary care doctor or an endocrinologist, and it is the step most likely to protect your independence over the years ahead. It matters even more if spine surgery with screws (a fusion) is on the table, because weak bone is the single biggest reason hardware loosens and a fusion fails to heal.

1

Measure the bone

A DEXA scan measures bone density and gives a T-score. If you have already had a recent CT of the chest, abdomen, or spine, the density of the bone on that scan (its Hounsfield units) can be read at no extra cost or radiation, and is often more reliable than DEXA when the spine has a lot of arthritis.

2

Correct the basics

Adequate calcium and vitamin D, protein, strength and balance exercise, stopping smoking, and limiting alcohol all support bone and improve the odds that any surgery heals.

3

Rule out other causes

Blood tests look for treatable contributors to bone loss; when a fracture looks unusual, imaging helps exclude a tumor or infection.

4

Start bone medication

Depending on your risk, a bone-building (anabolic) or bone-protecting (antiresorptive) medication is started. For higher-risk bone — and before a planned fusion — a bone-building drug started first is often the better choice.

5

Prevent falls

Home-safety changes, vision checks, and reviewing medicines that cause dizziness reduce the falls that trigger fractures.

Bone Medications, in Brief

Antiresorptives — slow bone loss
Bisphosphonates (weekly/monthly pill or a yearly infusion) and denosumab (an injection every six months) reduce further breakdown. Often first-line for moderate risk. Denosumab must never be stopped without a planned hand-off to another drug, because bone loss rebounds quickly.

Anabolics — build new bone
Teriparatide (daily injection) and abaloparatide (daily injection) switch bone-building on; romosozumab (a monthly injection) both builds bone and slows loss. These are reserved for high- and very-high-risk bone — including a spine fracture like yours — and are typically given for a defined course, then followed by an antiresorptive to lock the gains in.

Sequence matters
For very-high-risk bone, building first with an anabolic and protecting afterward gains more density than starting with a bisphosphonate. Going in the other order blunts the anabolic’s effect.

Which medication fits depends on your fracture risk, kidney function, dental health, cardiovascular history, and other factors, decided with your bone-health physician. This is general education, not a prescription.

The Numbers Your Team Watches

Clinical reference

These are the specific thresholds clinicians use to decide when bone is weak enough to act on, and when it is weak enough to change a surgical plan. They are shared here for transparency; your own targets are set by your physicians.

DEXA T-score

Normal≥ −1.0
Low bone mass (osteopenia)−1.0 to −2.5
Osteoporosis≤ −2.5

A fragility fracture — like a compression fracture — counts as osteoporosis on its own, whatever the T-score says. DEXA can also read falsely high when the spine has arthritis or calcified vessels, so a “normal” DEXA does not fully clear weak bone.

CT Hounsfield units (L1)

Reassuring> 160 HU
Intermediate110–160 HU
Osteoporosis range< 110 HU

Measured from a CT you may already have. For spine surgery with screws, the risk of loose hardware and a fusion not healing climbs as this number falls; many surgeons treat roughly < 120 HU at the levels being fixed as a red flag worth optimizing before elective surgery.

When we worry

Any one of these tips bone from “monitor” to “treat, and optimize before elective surgery”:

A prior fragility or vertebral fracture
T-score ≤ −2.5, or L1 CT < ~120 HU
High 10-year fracture risk (FRAX)
A planned long or multi-level instrumented fusion

If a Fusion Is Planned — Optimize the Bone First

Most compression fractures never need screws. But when a fusion is planned in osteoporotic bone, treating the bone before the operation measurably improves the odds that it heals. Screws hold better in denser bone, cages are less likely to sink, and the fracture rate at the top of a construct falls.

The strongest evidence is for anabolic (bone-building) therapy. When the timeline allows, starting an anabolic such as teriparatide roughly 2–3 months before an elective fusion and continuing it for 6–12 months after has been associated with higher fusion rates (about 82% versus 68% with a bisphosphonate in one representative series) and fewer loose screws. The bone-building course is then followed by an antiresorptive to hold the gains.

This is always balanced against how urgent the surgery is: an unstable fracture or a nerve at risk is treated promptly and the bone is optimized around the operation rather than delaying it. The plan is made jointly by your spine surgeon and a bone-health physician.

Compare Your Options

Vertebroplasty vs. Kyphoplasty

Both inject bone cement to splint a painful fracture through a needle in the pedicle. The difference is whether a balloon is used first to make a cavity and lift the bone. The best choice depends on your fracture and is decided with your surgeon.

Feature	Vertebroplasty	Balloon Kyphoplasty
What it does	Injects cement directly into the fractured bone	Inflates a balloon to make a cavity, then fills it with cement
Restores height?	Minimal	Can restore some lost height
Adds hardware?	No — cement only	No — cement only
Anesthesia	Local with sedation, or general	Local with sedation, or general
Cement leak risk	Slightly higher (no contained cavity)	Lower (cement placed into a cavity)

Consideration	Vertebroplasty	Kyphoplasty
Painful fracture, little height loss	Well suited	Also suitable
Painful fracture with height loss	Stabilizes but will not lift	Preferred; can re-lift the bone
Very collapsed / hard to reach	Sometimes chosen	Cavity creation can help
Unstable or burst fracture	Not appropriate alone	Not appropriate alone

Factor	Vertebroplasty	Kyphoplasty
Hospital stay	Usually same day	Usually same day
Pain relief timing	Often within a day or two	Often within a day or two
Posture correction	None expected	Some, if done early
Next-level fracture risk	Present; treat the bone	Present; treat the bone

Neither is universally better. For a painful fracture with meaningful height loss we often favor kyphoplasty; for a painful fracture with little collapse, either can work well. Both depend entirely on choosing the right fracture in the first place.

Frequently Asked Questions

Common Questions

Do I need a procedure, or will the fracture heal on its own?

Most osteoporotic compression fractures heal over six to twelve weeks with pain control, a brace for comfort, and gentle activity, so waiting is reasonable for many people. A procedure is considered when the pain is severe or is not improving with a fair trial of non-surgical care. Either way, the underlying bone should be evaluated and usually treated.

What is the difference between vertebroplasty and kyphoplasty?

Both inject bone cement into the fractured vertebra through a needle to splint it and relieve pain. In kyphoplasty, a balloon is first inflated inside the bone to create a cavity and lift the collapsed endplate, which can restore some lost height before the cement goes in. Vertebroplasty injects cement without a balloon. Kyphoplasty is often chosen when there is meaningful height loss to correct.

Will cement fix my stooped posture?

Treating one fresh fracture, especially with kyphoplasty done early, can recover a little height and forward tilt at that level. But a stoop that has built up over years from earlier collapsed fractures is largely fixed in place, and augmentation does not reverse it. The most important thing you can do for your posture going forward is to prevent the next fracture by treating the bone.

Is the procedure painful, and how long does it take?

Cement augmentation is usually done through a small needle with local anesthetic and sedation, or sometimes general anesthesia, and often takes under an hour for a single level. Most people go home the same day. There is typically some soreness at the needle site for a few days, but the fracture pain itself often improves quickly.

Could treating one level make the next one break?

A vertebra that has been filled with cement is stiffer than the soft, osteoporotic bones around it, and there is some evidence that the neighboring levels can be at higher risk of fracturing. The bigger driver, though, is that all of your bone is still weak. This is exactly why we pair any procedure with a bone-health plan rather than treating fractures one at a time.

When does a compression fracture need actual surgery with screws?

Cement alone is not enough when a fracture is unstable: a burst pattern that breaks the back wall of the vertebra, a fragment pushed toward the spinal canal, significant deformity, or any sign that a nerve or the spinal cord is being compressed. In those cases the spine is stabilized with screws and rods, and the canal is decompressed if needed. These situations are the exception, not the rule.

Why did my bone break from something so minor?

That is the key question. Breaking a bone from a minor force is called a fragility fracture, and it usually means osteoporosis has quietly weakened the bone over years. It is not a personal failing, and it is treatable. A bone-density scan and a few tests can clarify how weak the bone is and why, and medication can meaningfully lower the risk of another fracture.

Our Team

Who We Are

This educational resource was developed by the Division of Spine and Spine Tumor Neurosurgery at Brown University Health to help patients and families understand vertebral compression fractures and their treatment. Our surgeons offer the full spectrum of care, from cement augmentation to stabilization for unstable fractures, and work closely with primary care, endocrinology, and physiatry so that both the fracture and the underlying bone are treated.