Osteoporotic Fractures of the Spine

Osteoporotic vertebral compression fractures (OVCFs) are common fragility fractures associated with aging, pain, spinal deformity, and increased risk of subsequent fractures. Computed tomography and MR imaging are central to diagnosis and differential evaluation from malignant fractures. Acute OVCFs demonstrate marrow edema with partial preservation of fatty marrow. Advanced MR imaging techniques improve diagnostic confidence. Diffusion-weighted imaging shows relatively higher apparent diffusion coefficient values in benign fractures. Most patients respond favorably to conservative management emphasizing analgesia, early mobilization, rehabilitation, and osteoporosis-directed therapy. Vertebral augmentation remains controversial and should be reserved for carefully selected patients with acute fractures and severe refractory pain.