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Osteoporosis and the Spine: When Back Pain May Be a Compression Fracture

A photo of Dr Colum Nolan, Senior Consultant Neurosurgeon of Oxford Spine & Neurosurgery Centre

Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Osteoporosis weakens bone and increases the risk of vertebral compression fractures — small collapses in the spinal bones that can occur after a fall, a minor strain, or sometimes with no clear injury. These fractures are a common but often overlooked cause of new or persistent back pain, particularly in older adults and post-menopausal women.

In a spine clinic setting, the focus is not only on whether osteoporosis is present, but also on whether your symptoms are due to a spinal fracture, progressive collapse, spinal imbalance, or nerve compression, and what treatment is appropriate.

How Osteoporosis Can Cause Back Pain

A vertebral compression fracture may cause:
  • Sudden onset of back pain (mid-back or lower back), sometimes after a minor trigger (lifting, twisting, coughing)
  • Pain that is worse when standing or walking and may ease with lying down
  • Local tenderness over the spine
  • Pain that persists despite usual “muscle strain” care
Over time, repeated fractures can lead to height loss and a more stooped posture (kyphosis), which can further strain the back.

Symptoms That Suggest Nerve Involvement

Most osteoporotic fractures cause mechanical pain. However, if fracture-related collapse or spinal alignment changes contribute to narrowing around nerves, symptoms may include:
  • Radiating pain into the buttock or leg
  • Numbness or tingling
  • Weakness or heaviness in the leg
  • Reduced walking tolerance
These symptoms require careful assessment because treatment may need to address both fracture stability and nerve compression.

When to Seek Urgent Medical Attention

Seek urgent care if you develop:
  • New or worsening leg weakness
  • Numbness around the groin/saddle area
  • Loss of bladder or bowel control
Severe pain after a fall or injury

How Is Osteoporosis Assessed and Diagnosed?

Assessment typically includes:

Clinical evaluation

A clinician will review your pain pattern, triggers, function, and any neurological symptoms, and examine posture, spinal tenderness, walking, strength, sensation, and reflexes.

Imaging (when needed)

  • X-rays can show vertebral height loss and alignment changes
  • MRI can help confirm an acute fracture and assess for nerve compression
  • CT may be used for bony detail in selected cases

Treatment Options

Treatment depends on fracture severity, stability, pain level, alignment, and whether nerves are affected.

Non-surgical management

Many cases are treated without surgery, which may include:
  • Pain control strategies and guidance on safe movement
  • Gradual mobilisation (avoiding prolonged bed rest)
  • Physiotherapy focused on posture, strength, and confidence with movement
  • Bracing in selected cases

When procedures or surgery may be considered

Further intervention may be discussed when:
  • Pain remains severe despite appropriate non-surgical care
  • There is significant collapse or instability affecting posture and function
  • Imaging shows nerve compression with persistent leg symptoms or weakness
Surgical goals may include:
  • Stabilising the affected level (when needed)
  • Relieving pressure on nerves if nerve compression is present

Speak to Oxford Spine & Neurosurgery Centre

Back pain is not always due to discs or “wear and tear”. In some people, it may relate to osteoporosis-related spinal fractures, collapse, or nerve compression. At Oxford Spine & Neurosurgery Centre, Dr Colum Nolan combines clinical assessment with detailed imaging review to clarify the cause of symptoms and recommend an appropriate treatment plan. Contact us to book an appointment with Dr Colum Nolan today.


Medical disclaimer

This page is for general education and does not replace a medical consultation. If you have severe pain, progressive weakness, or bladder/bowel changes, seek urgent medical attention.

Our Spine & Neurosurgeon in Singapore
Dr Colum Nolan
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Dr Colum Nolan is a Senior Consultant Neurosurgeon with over 20 years of experience, specialising in minimally invasive spine (keyhole) surgery and other spine procedures. 

A graduate of the Royal College of Surgeons in Ireland, Dr Nolan underwent neurosurgical training in Ireland and Australia, followed by a fellowship in complex spine surgery at Addenbrooke’s Hospital, Cambridge, as well as rotations at the Orthopaedic Spine Unit in Norfolk and Norwich Hospital. 

Dr Colum is committed to delivering compassionate, patient-centred care, combining surgical precision with a genuine dedication to improving his patients’ quality of life.

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