{"id":27885,"date":"2026-05-14T09:31:10","date_gmt":"2026-05-14T08:31:10","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=27885"},"modified":"2026-08-07T08:19:33","modified_gmt":"2026-08-07T07:19:33","slug":"suspected-vertebral-fragility-fractures","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/suspected-vertebral-fragility-fractures\/","title":{"rendered":"Suspected vertebral fragility fractures"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Red flags include<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sudden onset of severe central spinal pain which is relieved by lying down<\/li>\n\n\n\n<li>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<\/li>\n\n\n\n<li>Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra) may be present<\/li>\n\n\n\n<li>There may be point tenderness over a vertebral body.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Key risk factors<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Older age (&gt;50 years for women and &gt;65 years for men)<\/li>\n\n\n\n<li>Previous fragility fracture<\/li>\n\n\n\n<li>Long term glucocorticoids<\/li>\n\n\n\n<li>History of falls<\/li>\n\n\n\n<li>Family history of hip fracture<\/li>\n\n\n\n<li>Other causes of secondary osteoporosis, e.g., RA &amp; problems with malabsorption<\/li>\n\n\n\n<li>Low body mass (&lt;18.5kg\/m2)<\/li>\n\n\n\n<li>Smoking<\/li>\n\n\n\n<li>Alcohol intake &gt;3.5 units \/day<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">History<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sudden pain in thoracic or lumbar spine<\/li>\n\n\n\n<li>Minimal trauma<\/li>\n\n\n\n<li>Pain that gets worse when sitting (esp. a straight-backed chair) &amp; leaning backwards or standing leaning forwards.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Physical Examination<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>No clinical signs specific for VFF<\/li>\n\n\n\n<li>In acute phase may have: Local tenderness \/ pain on percussion over spine level<\/li>\n\n\n\n<li>Potential for: Height loss of person &gt; 2.5cm<\/li>\n\n\n\n<li>Thoracic kyphosis.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Why is it important to identify a VFF<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A vertebral fracture is a powerful predictor of another vertebral fracture (5x more likely) &amp; of future hip fracture (3x more likely) without treatment (<a href=\"https:\/\/strwebprdmedia.blob.core.windows.net\/media\/fcodhs1m\/state-of-the-nation-report-vertebral-fracture-identification-in-2021.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ROS, 2021<\/a>).<\/li>\n\n\n\n<li>There are high rates of mortality within the first year after fragility fractures such as the hip (<a href=\"https:\/\/www.bristol.ac.uk\/media-library\/sites\/medical-school\/a%20guide%20to%20diagnosis%20for%20healthcare%20professionals%20in%20primary%20care.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">The Vertebral Fractures Study, 2022<\/a>).<\/li>\n\n\n\n<li>All patients with a VFF should be considered for fracture risk assessment to reduce fracture risk and prevent further fractures (<a href=\"https:\/\/strwebprdmedia.blob.core.windows.net\/media\/x0hffxye\/ros-guidance-on-managing-symptoms-of-vertebral-fractures-2022.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ROS, 2022<\/a>).<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Relevant Resources<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">SIGN Guideline 142 &#8211;&nbsp;<a href=\"https:\/\/www.sign.ac.uk\/media\/1812\/sign-142-osteoporosis-v3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Osteoporosis and the prevention of vertebral fragility fractures.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; P.A &#8211; 14-05-26<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Red flags include Key risk factors History Physical Examination Why is it important to identify a VFF Relevant Resources SIGN Guideline 142 &ndash;&nbsp;Management of Osteoporosis and the prevention of vertebral fragility fractures. M.A &amp; P.A &ndash; 14-05-26<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1388,1390],"class_list":["post-27885","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-serious-cervical-spine-conditions-red-flags","category-https-apps-nhslothian-scot-refhelp-suspected-vertebral-fragility-fractures"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/https-apps-nhslothian-scot-refhelp-serious-cervical-spine-conditions-red-flags\/\" rel=\"tag\">Serious Cervical Spine Conditions<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/cervical-thoracic-spine\/https-apps-nhslothian-scot-refhelp-serious-cervical-spine-conditions-red-flags\/https-apps-nhslothian-scot-refhelp-suspected-vertebral-fragility-fractures\/\" rel=\"tag\">Suspected Vertebral Fragility Fractures<\/a>","rttpg_excerpt":"Red flags include Key risk factors History Physical Examination Why is it important to identify a VFF Relevant Resources SIGN Guideline 142 &ndash;&nbsp;Management of Osteoporosis and the prevention of vertebral fragility fractures. M.A &amp; P.A &ndash; 14-05-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27885","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=27885"}],"version-history":[{"count":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27885\/revisions"}],"predecessor-version":[{"id":27888,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27885\/revisions\/27888"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=27885"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=27885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}