What is a vertebral compression fracture?

The spine is a stack of small bones called vertebrae. With osteoporosis, the bones become thin and fragile and one of them can collapse. Sometimes there’s a clear cause — a fall, a heavy lift, a hard sneeze. Often there isn’t. The result is sudden, severe pain in the middle or lower back, often pinpointed to one spot, that gets worse with standing, walking, or bending. Over time, multiple fractures cause height loss, a stooped posture (sometimes called a “dowager’s hump“), and the loss of independence that comes with no longer being able to do everyday things comfortably.

Compression fractures aren’t only caused by osteoporosis. Multiple myeloma, spinal metastases from cancers like breast or prostate, and rare conditions like aggressive vertebral hemangiomas can also cause painful fractures — and the same procedures can help.

Why this matters — the evidence

For appropriately selected patients with painful vertebral compression fractures, vertebral augmentation has been studied extensively in randomized controlled trials, the highest level of medical evidence:

• The VAPOUR trial showed that vertebroplasty produced significantly better pain relief than placebo in patients with severely painful, acute fractures.²
• The VERTOS II and VERTOS IV trials confirmed faster pain relief and better function with vertebroplasty compared to optimal pain medication management.³
• The FREE trial showed kyphoplasty improved pain, function, and quality of life compared to non-surgical care.⁴

This evidence base — and the procedure’s safety record — is why vertebral augmentation is recognized in ACR Appropriateness Criteria, Society of Interventional Radiology practice guidelines, and joint position statements of multiple specialty societies.

Vertebroplasty or kyphoplasty?

Both procedures stabilize a broken vertebra by filling it with medical-grade bone cement called polymethylmethacrylate (PMMA), which hardens within minutes. The difference is in how the cement is delivered:

• Vertebroplasty — bone cement is injected directly into the vertebra through a thin needle under live X-ray.
• Kyphoplasty (balloon kyphoplasty) — a small balloon is first inflated inside the vertebra to create a cavity and partially restore lost height; cement is then placed into the cavity.

The choice depends on the type and age of the fracture, how much height has been lost, and the surrounding anatomy. Both have strong evidence behind them.

Cómo se presenta el día

You’ll arrive in the morning. After paperwork and an IV, you’ll lie face-down on a soft padded table — most patients tolerate this well, even with painful fractures, because of the extra support. The procedure is done under conscious sedation with local numbing medication; you won’t need general anesthesia. Live X-ray guides a thin needle through the skin and into the broken vertebra. Bone cement is injected, the cement hardens in minutes, and the procedure is over. The whole thing typically takes 30 to 60 minutes per level. After a short recovery, you go home the same day. Most patients begin to feel substantial pain relief within 24 to 72 hours and walk comfortably the following day.

Treating the fracture isn’t enough

This is the most important part. Having one osteoporotic vertebral fracture significantly increases your risk of another within the next year. Stabilizing the fracture in front of you brings relief — but the next fracture is the one we want to prevent. After your procedure, we coordinate with your primary care physician, geriatrician, endocrinologist, or rheumatologist to ensure you have a complete bone-health plan: calcium and vitamin D, fall prevention, and a bone-density-appropriate medication. The choices include bisphosphonates (alendronate, risedronate, zoledronic acid), denosumab (Prolia), romosozumab (Evenity), or anabolic agents like teriparatide (Forteo) and abaloparatide (Tymlos). Your full team chooses what fits your bone density, kidney function, and medical history.

¿Quién es un buen candidato?

The best candidates are patients with acute or subacute painful vertebral compression fractures — typically less than three months old — confirmed on MRI, where pain is severe enough to limit normal activity or where prolonged bed rest poses serious risk. We are happy to review your imaging and history before the procedure and walk you and your family through what to expect.

Referencias

1. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465–475.
2. Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408–1416.
3. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085–1092.
4. Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016–1024.

Preguntas frecuentes

What is a vertebral compression fracture?

A vertebral compression fracture is a break in one of the small bones (vertebrae) that make up the spine. In older adults, the most common cause is osteoporosis — the bones become thin and fragile, and a vertebra can collapse from a small fall, a sneeze, or sometimes from no clear injury at all. The result is sudden, severe pain in the middle or lower back, height loss, and a stooped posture. These fractures are common (more than 700,000 per year in the US) and are an important and treatable cause of disability and decline in older adults.

What are vertebroplasty and kyphoplasty?

Vertebroplasty and kyphoplasty are both image-guided procedures that stabilize a broken vertebra by injecting a small amount of medical-grade bone cement into it. In vertebroplasty, the cement is injected directly. In kyphoplasty (also called balloon kyphoplasty), a tiny balloon is first inflated inside the vertebra to create a cavity and partially restore vertebral height; the cement is then placed into the cavity. Both procedures are performed through a thin needle under live X-ray guidance, with no incision.

How quickly will the pain go away?

Most appropriately selected patients feel significant pain relief within 24 to 72 hours after the procedure. The cement hardens within minutes and stabilizes the fracture so the bone fragments no longer move with breathing or movement, which is the source of much of the pain. Many patients are walking comfortably the next day.

Is there evidence that these procedures work?

Yes. Multiple randomized controlled trials — the gold standard of medical evidence — have shown that vertebral augmentation provides better pain relief and faster return to function than non-operative care for appropriately selected patients with painful vertebral compression fractures. The VAPOUR trial showed clear benefit for severely painful acute fractures in patients at high risk from immobility. The VERTOS II and VERTOS IV trials and a number of meta-analyses support vertebral augmentation as a safe and effective option.

Is vertebroplasty covered by Medicare?

Vertebroplasty and kyphoplasty are widely covered by Medicare and most commercial insurance plans for appropriately selected patients with painful vertebral compression fractures. Coverage details vary by plan and indication. Our office can help confirm coverage before the procedure.

What about preventing the next fracture?

This is the most important question. Having one osteoporotic vertebral fracture significantly raises the risk of another. Vertebroplasty treats the fracture in front of you; long-term bone-health treatment is what prevents the next one. After the procedure we coordinate with primary care, geriatrics, endocrinology, or rheumatology to ensure you have a complete plan — calcium and vitamin D, fall prevention, and a bone-density-appropriate medication such as a bisphosphonate, denosumab, romosozumab, teriparatide, or abaloparatide.

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