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Osteoporotic Vertebral Fracture

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Checked: 21-05-2024 by Rob Adams Next Review: 21-05-2026

Overview

Diagnosing Osteoporotic Vertebral Fractures (1,2,3)

Vertebral fractures involve the collapsing of a vertebra in the spine in a process of ‘compression’.
Vertebral fractures are the most common osteoporotic fracture.
Vertebral fractures can occur spontaneously. They can also happen following a fall from a short height.
NICE recommends prescribing bone protection therapies to people who have experienced a prior fragility fracture, to reduce the risk of further fractures.

What are the risk factors for osteoporotic vertebral fractures?

Aged 50 years or over.
Previous fragility fractures.
Current use or frequent recent use of oral or systemic glucocorticoids.
History of falls.
Family history of hip fracture.
Other causes of secondary osteoporosis such as rheumatoid arthritis and problems with malabsorption.
Low body mass index (BMI) (less than 18.5kg/m2).
Smoking.
Alcohol intake of more than 14 units per week.

Investigations (1)

Plain spinal radiographs are the first imaging of choice. Separate lumbar and thoracic views are better than a single thoracolumbar radiograph, as this can miss vertebrae.

The referral should be made via ICE and highlight the concern about the presence of an osteoporotic vertebral fracture.

BNSSG Pathway for Vertebral Fractures

The BNSSG Osteoporotic Vertebral Fracture Care Pathway (2017) is under review and the new guidance will be published shortly.

Please note: All referrals should now go via the Spinal Fracture Trauma (RAS) on eRS and not sent via email.

Please see the Spinal Fractures section of the Fracture Clinics page for further information.

Red Flags

If an acute unstable vertebral fracture or spinal injury is suspected then refer to ED.

If more urgent advice or referral is required then refer via the ‘Refer a Patient’ Neurosurgery portal. Please see the Neurosurgery page for further information.

Referral

Vertebroplasty

Referrals for consideration of vertebroplasty should be directed the Spinal Fracture Trauma RAS service at NBT via eRS (referrals via email are no longer accepted).

Referrals will be triaged and suitable patients will be sent an appointment. Referrals not meeting criteria for this service may be returned with advice.

Osteoporosis

Please see the Osteoporosis page for further information on treatment and referral of patients with osteoporosis.

Resources

Healthcare professional resources

(1) Could your patient have a vertebral spinal fracture? (PDF, 818kB)

(‌2) A guide to diagnosis for healthcare professionals in primary care (PDF, 1,178kB)

(3) Diagnosing - Hints and tips (PDF, 482kB)‌

Patients

Could you have a vertebral spinal fracture? (PDF, 1,111kB)‌‌

A guide to diagnosis for patients and carers (PDF, 1,636kB)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.