Don’t Wait 10 Weeks: When to Refer Your Compression Fracture Patients
- The Review Course in Family Medicine
- May 9
- 2 min read
Thanks to the UBC family medicine residents for hosting me at their site academic half day - got some great clips of fundoscopy for our upcoming video!
-Simon
Let's crush this topic!
I've seen some patients in clinic with extreme pain from this diagnosis…and others are asymptomatic!
A patient presents with acute back pain after simply turning in bed or sneezing. We looked at an American Family Physician article published in 2026 on this topic.
The High-Yield Takeaway:
Most fractures are asymptomatic.
Diagnosis requires 20% height loss.
Initial treatment is always conservative - BUT for this condition, conservative means medication!
Surgery helps if pain persists.
To help this stick, pause and consider this. Which physical exam maneuver has the highest sensitivity for a Vertebral Compression Fracture?
The answer from the question above: The Back Pain-Inducing Test. This test is 99% sensitive. We perform this by having the patient move from sitting to lying. Then they roll side to side. Finally, they sit back up.
Other tests: Closed-Fist Percussion Test & Supine Sign Test (see videos in the source)
Diagnosis: Start with Anteroposterior and lateral radiography. If results are negative but suspicion is high, order Magnetic Resonance Imaging. This can differentiate between acute and chronic fractures. Computed Tomography is an alternative if Magnetic Resonance Imaging is unavailable. Magnetic Resonance Imaging with contrast is required if the patient has a history of malignancy.
Management: Conservative measures (meaning medication in this case, not surgery) are the mainstay of treatment. The goal is to regain mobility and mitigate pain.
Acetaminophen and Nonsteroidal Anti-inflammatory Drugs.
Anti-osteoporotic medications like Bisphosphonates.
Teriparatide for acute pain.
Physical Rehabilitation initiated after two weeks.
Bracing for a maximum of eight weeks.
CANADIAN CONTEXT: Calcitonin is not available in Canada - it was pulled from the market due to cancer concerns.
When to refer: Consider surgical intervention if pain persists after six weeks of conservative care. Percutaneous Vertebroplasty and Balloon Kyphoplasty are effective options. Both procedures provide rapid and sustained pain relief. Kyphoplasty is better for restoring vertebral height but costs more. These procedures can improve long-term mortality.
EXAM TIP: When studying for the MCQ-SAMPs, be sure to consider Magnetic Resonance Imaging as the second-line test. A common trap is assuming Radiography is always sufficient. If a patient has a high clinical suspicion but normal X-rays, failing to choose Magnetic Resonance Imaging could cost marks. This is especially true in patients with a history of cancer.
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