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Vertebral Compression Fractures in Osteoporotic and Pathologic Bone pp 49–55Cite as

Biomechanics of Vertebral Compression Fractures

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Abstract

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures that occur in the United States each year with an estimated incidence of over 700,000 occurring annually (Ensrud and Schousboe, Bone 364:1634–1642, 2011; Riggs and Melton, Bone 17, 1995). These numbers are likely a gross underestimate of the true incidence based on the delay in clinical presentation that is frequently associated with compression fractures (Ensrud and Schousboe, Bone 364:1634–1642, 2011; Riggs and Melton, Bone 17, 1995; Fink, J Bone Miner Res 20(7):1216–1222, 2005; Melton, Am J Epidemiol 129(5):1000–1011, 1989). While decreased bone mineral density secondary to age, endocrinopathies, or other systemic conditions play a large role in the pathophysiology of compression fractures, these factors alone do not explain the common fracture patterns that afflict the osteoporotic population.

In order to fully understand the pathophysiology and management of compression fractures, knowledge of the normal anatomy and physiology of the vertebral column is necessary. Examining the vertebral body, the intervertebral disc, and the biomechanical stresses that act upon them with normal physiologic forces explains why certain fractures occur in predictable locations and patterns.

This understanding gives rise to a morphologic fracture classification that includes anterior wedge, biconcave, and crush fracture patterns, though many different classification systems have also been described. These fracture patterns are largely explained by the unique anatomy and physiology of the vertebral bodies and the adjacent intervertebral discs.

The mechanism by which VCFs cause pain is also worth examining. Multiple studies have shown that VCFs cause pain through multiple mechanisms, though there does not appear to be one predominant pathophysiology. When observing pain patterns associated with VCFs, it is worth differentiating the patients who experience acute pain at the time of injury versus those who experience a more delayed and chronic pain, as the pathophysiology differs significantly.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Peter J. Ostergaard & Thomas D. Cha

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  1. Peter J. Ostergaard
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  2. Thomas D. Cha
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Correspondence to Thomas D. Cha .

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Editors and Affiliations

  1. Vice Chair and Residency Program Director, Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA

    Afshin E. Razi

  2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Stuart H. Hershman

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Ostergaard, P.J., Cha, T.D. (2020). Biomechanics of Vertebral Compression Fractures. In: Razi, A., Hershman, S. (eds) Vertebral Compression Fractures in Osteoporotic and Pathologic Bone. Springer, Cham. https://doi.org/10.1007/978-3-030-33861-9_5

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  • DOI: https://doi.org/10.1007/978-3-030-33861-9_5

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