Condition guide
In someone with osteoporosis, a vertebra can collapse even without a fall: when coughing, bending or lifting something. Sudden back pain, loss of height or a rounding of the back can be a sign of this; sometimes there are no symptoms at all. Most fractures heal in 6–12 weeks. You do not need to lie still: moving safely and exercising support your pain and mobility, while bone treatment helps prevent new fractures.
Osteoporosis itself does not cause pain unless a bone breaks. Some vertebral fractures, however, happen without any pain. Osteoporotic vertebral fractures are “stable” fractures; they do not affect the spinal cord and do not cause paralysis.
A UK primary care guide recommends suspecting a vertebral fracture when there is back pain, especially in older people and those with risk factors. The diagnosis is made with separate X-rays of the upper and lower back. If a fracture is found, fracture risk is calculated, bone density is measured if needed (DEXA), and blood tests are done for other causes that weaken bone. In suitable people, bone-strengthening medicine reduces the risk of a new fracture by 30–50%.
A 2019 Cochrane review looked at 9 trials involving 749 people who had had a vertebral fracture. Exercise shortened the time on the timed up and go test by an average of 1.1 seconds (moderate-certainty evidence); this difference is small in clinical terms. Its effect on pain, quality of life, falls and new fractures remained uncertain. In the PROVE trial in the UK, with 615 people, a 7-session exercise programme improved physical performance at 4 months more than a single advice session, but by 12 months there was no difference between the groups.
Although the evidence is limited, UK expert consensus recommends exercise: it may reduce pain and improve mobility and quality of life; strength and balance training helps prevent falls, and exercises that straighten the back improve posture.
If you have had a vertebral fracture: keep impact at the level of brisk walking; avoid bending your back far forwards when lifting and in daily life; if you need to bend, bend from your hips.
Exercises at home
The Royal Osteoporosis Society recommends holding each position in its back pain exercises for 3–5 seconds while continuing to breathe, and doing the exercises at least once a day. Work slowly and with good technique, as far as your pain allows; the other repetition numbers are general suggestions. If you have more than one fracture, talk to a physiotherapist first.
Lean your back and head against a wall, with your feet a step away from the wall. Tuck your chin in slightly and open your chest; hold for a few seconds while breathing comfortably.
Hold for 3–5 seconds, 5 reps, at least once a daySit or stand upright. Without lifting your shoulders, draw your shoulder blades back and slightly down towards each other. Keep breathing.
Hold for 3–5 seconds, 5–10 reps, at least once a dayWhen you need to reach the floor or something low, bend your knees and lean forwards from your hips instead of rounding your back; keep your back straight. When picking something up, keep the load close to your body.
Every time you bend in daily lifeSit towards the front of a sturdy chair. Keeping your back straight, lean forwards, stand up and sit down slowly. Use your hands for support if needed.
8–10 reps, 1–2 setsStand beside a worktop with one foot directly in front of the other. Hold onto the worktop if needed; as it gets easier, hold on less.
10 seconds, 2–3 times with each foot in frontStart on a level path at a comfortable pace; as your pain eases, gradually increase the time and pace. If you have had a vertebral fracture, stay at the level of brisk walking rather than jumping and running.
Start with a few minutes; aim for 30 minutes a dayUsually not. An adviser to the Royal Osteoporosis Society explains that osteoporotic vertebral fractures are “stable” fractures that do not affect the spinal cord, and that there is no need to wear a brace. You do not need to stay still either; regular movement and suitable exercises are recommended. If your doctor has given you advice specific to your situation, follow it.
Most fractures heal on their own in 6–12 weeks, and the pain usually eases during this time. Strong painkillers may be needed in the first few days, and the dose is reduced as the pain eases. In some people, especially when several fractures have changed the shape of the spine, the pain can go on for a long time; in that case support such as a pain clinic and physiotherapy helps.
Yes; according to UK expert consensus, there is little evidence that physical activity causes serious harm, and the benefits generally outweigh the risks. Recommendations for people who have had a vertebral fracture: keep impact at the level of brisk walking, avoid bending the back far forwards in exercise and daily life, and if you are at risk of falling, start with strength and balance training first. In the Cochrane review, exercise-related side effects were rare; four events in total, including a rib fracture, were reported in three trials.
In the PROVE trial in the UK, with 615 people, a 7-session exercise programme gave better results on physical performance tests at 4 months than a single one-hour physiotherapy advice session. By 12 months, however, there was no difference between the groups in quality of life or muscle endurance. Even a single, well-explained advice session matters; the intensity and length of the programme can be tailored to the person.
In suitable people, bone-strengthening medicine reduces the risk of a new fracture by 30–50%; you can discuss this with your doctor. Assessing your risk of falling, doing strength and balance exercises, and protecting your back when bending and lifting are also important.
About two thirds of vertebral fractures remain undiagnosed. The pain can be mistaken for ordinary muscle pain, and some fractures cause no pain at all. Only about 20% of fractures happen after a fall; most happen during everyday tasks such as coughing, bending or lifting something.
For safe exercise in osteoporosis, see the osteoporosis guide; for a rounded upper back, the hunched posture guide; and to reduce your risk of falling, the falls prevention guide.
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