Red flags include
- Sudden onset of severe central spinal pain which is relieved by lying down
- There may be a history of trauma (such as road traffic collision or fall from height), minor trauma, or even just strenuous lifting in people with osteoporosis or those who use corticosteroids
- Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra) may be present
- There may be point tenderness over a vertebral body.
Key risk factors
- Older age (>50 years for women and >65 years for men)
- Previous fragility fracture
- Long term glucocorticoids
- History of falls
- Family history of hip fracture
- Other causes of secondary osteoporosis, e.g., RA & problems with malabsorption
- Low body mass (<18.5kg/m2)
- Smoking
- Alcohol intake >3.5 units /day
History
- Sudden pain in thoracic or lumbar spine
- Minimal trauma
- Pain that gets worse when sitting (esp. a straight-backed chair) & leaning backwards or standing leaning forwards.
Physical Examination
- No clinical signs specific for VFF
- In acute phase may have: Local tenderness / pain on percussion over spine level
- Potential for: Height loss of person > 2.5cm
- Thoracic kyphosis.
Why is it important to identify a VFF
- A vertebral fracture is a powerful predictor of another vertebral fracture (5x more likely) & of future hip fracture (3x more likely) without treatment (ROS, 2021).
- There are high rates of mortality within the first year after fragility fractures such as the hip (The Vertebral Fractures Study, 2022).
- All patients with a VFF should be considered for fracture risk assessment to reduce fracture risk and prevent further fractures (ROS, 2022).
Relevant Resources
SIGN Guideline 142 – Management of Osteoporosis and the prevention of vertebral fragility fractures.
M.A & P.A – 14-05-26
