What percentage of vertebral compression fractures are symptomatic?
Only 1/3 of vertebral compression fractures are symptomatic. Approximately 2/3 are asymptomatic and are found incidentally on x-rays obtained for other indications. For most symptomatic fractures there is no history of antecendant trauma. Often women will complain of sudden pain after simple maneuvers such as bending, laughing, coughing, lifting or minor trauma such as going over a speed bump. When symptomatic, women may complain of pain radiating into the anterior abdomen in the distribution of contiguous nerve roots otherwise known as the “girdle of pain.” Radiation into legs is rare and is more often associated with herniated discs. Pain tends to lessen when supine and worsens with sitting, standing or movement. The intensity of pain varies between individuals. Initial imaging should be with plain x-ray. If your suspicion is high for compression fracture but the initial imaging is normal consider repeating the x-ray in two weeks if pain persists because some vertebrae do not collaps
