Mid-Back (Thoracic)

Osteoporotic Vertebral Compression Fracture

흉추 압박골절 (골다공증성)

Thoracic vertebral collapse from minor trauma on osteoporotic bone

Written and edited by Dr. Kwang Lee, D.C., L.Ac. · Updated 2026-10-04

How common: Common (25% of women >70)
Typical age: 70+, postmenopausal women

What is it?

Osteoporotic vertebrae collapse under minor loads (cough, sneeze, low falls).

Commonly affected: T11-L1 (thoracolumbar junction) most common

How it develops

Low Bone DensityPostmenopausal estrogen drop accelerates resorption
Microstructural WeakeningTrabecular disconnection
Low-Energy FractureEven cough produces anterior wedge fracture
Progressive KyphosisMultiple fractures → dowager's hump

Symptoms

Sudden mid-back painImmediate onset after minor trauma
Worse with weight-bearingWorse when standing or sitting
Relieved lying downDecreases in supine position
Height loss2–4+ cm loss with multiple fractures
Increased kyphosisChronic deformity

How it is examined

Focal spinous tendernessTenderness over fractured level spinous process
Percussion testFist percussion reproduces pain
Normal neurologicUsually no deficit
Kyphotic postureForward-flexed thoracic posture

Imaging

Lateral X-ray is primary — shows anterior wedging.

Anterior vertebral wedging
Height loss >20%
Often multi-level

MRI differentiates acute vs chronic — STIR hyperintensity = acute.

STIR hyperintensity (acute)
T1 hypointense marrow edema
Rule out posterior element involvement

Non-surgical care

Analgesics + restShort bed rest with acetaminophen/NSAIDs
TLSO braceTLSO brace 4–6 weeks
Osteoporosis treatmentBisphosphonates, denosumab, calcium, vitamin D
Progressive PTExtension and core exercises (avoid flexion)

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

Persistent severe pain >6 weeks, progressive deformity

Procedures that may be discussed

Percutaneous vertebroplasty
Balloon kyphoplasty

Outlook

Most improve in 6–12 weeks; osteoporosis therapy essential to prevent recurrence.