Whether you’re a neurosurgeon, a primary care physician, a rheumatologist or another specialist, you’ve likely seen patients who are suffering from vertebral compression fractures (VCFs). Some 1.5 million fractures of the thoracolumbar spine occur in the U.S. each year, and one in four postmenopausal women will experience a VCF in her lifetime.
Justin Sporrer, M.D., .
“Once a patient has had one vertebral compression fracture, their risk for another multiplies significantly. If you’ve had two VCFs, your risk for a third jumps 12 times,” says Justin Sporrer, M.D., director of functional neurosurgery at Baptist Health Miami Neuroscience Institute. “When the dominoes begin to fall, it tends to be a process that continues.”
Dr. Sporrer was one of the Institute experts who spoke at the 2025 Baptist Health Spine Symposium, where some 300 physicians and other healthcare professionals learned about the latest treatments for degenerative diseases of the spine.
A compression fracture can happen to anyone, yet older women are the most affected. Sometimes, it’s a fall, a car or sports accident or some other trauma that causes a break in a bone in the spine. It can also be cancer. But the most common cause is osteoporosis.
Treatment includes medication, physical therapy and orthotic braces, and, for some patients, surgery.
Minimally invasive surgery for compression fractures
“Kyphoplasty is a minimally invasive procedure that can be done very quickly,” Dr. Sporrer says. “Under local anesthesia, we inject a bone cement into the vertebrae. We have done this in 80- and 90-year-olds and in people who are 100. Most patients do very well, go home the same day and experience significantly less pain and improved mobility.”
A newer option for more severe fractures is armed augmentation, which, in addition to the cement, adds implants that can be supplemented with screws for additional strength and stability.
While robot-assisted kyphoplasty can be done, Dr. Sporrer says, using fluoroscopy to precisely navigate and visualize the area is just as safe and efficient. In addition, the “Robot-Assisted Kyphoplasty Versus Fluoroscopy-Assisted Kyphoplasty: A Meta-Analysis of Postoperative Outcomes” study revealed that there was no significant difference in pain on a visual pain scale between the subgroups at three and 12 months.
Vital to preventingVCFs — or their recurrence — is the assessment and treatment of osteoporosis.
Addressing osteoporosis and the risks
“Treatment should be two-fold,” Dr. Sporrer explains. “I see patients after the fact, when they already have a fracture. We must address the fracture and address the osteoporosis and address it very seriously.” Every patient with a VCF needs to see a rheumatologist, orthopedic surgeon, geriatrician or other osteoporosis specialist.
Risk factors for osteoporosis include:
- Being female and going through menopause early
- Having a family history of osteoporosis, particularly if either parent had a hip fracture
- Steroid use for several months at a time
- Aging
- Being of white or Asian descent
- Having other medical problems such as celiac disease, inflammatory bowel disease, cancer, rheumatoid arthritis, kidney disease or liver disease
- A low calcium intake, an eating disorder or a sedentary lifestyle
Using an online risk calculator such as FRAX (Fracture Risk Assessment Tool) helps determine the chances of a patient having an osteoporosis-related fracture in the next 10 years. A DEXA (dual X-ray technology) osteoporosis screening is recommended for women who are 65, or, for women with certain risk factors beginning at age 50, according to the U.S. Centers for Disease Control and Prevention. Depending on the risk, medications that slow bone loss or speed bone building may be prescribed along with lifestyle changes.
For patients who have already had a vertebral compression fracture, physicians can assess risk for a new VCF after kyphoplasty by looking at factors including body mass index, bone mineral density, vertebral body height before and after surgery and if the patient has had anti-osteoporosis treatment.
