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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Osteoporosis

When to Seek Help: Symptoms and Recognizing Fractures

At a Glance

In premenopausal osteoporosis, a fracture after a minor force may be the first sign of weak bones. New severe back pain, unexplained height loss, a rounded posture, or leg weakness and bladder changes should prompt medical evaluation.

Osteoporosis is often called a “silent disease” because bone loss itself does not cause pain [1]. For most premenopausal women, there are no outward symptoms until a bone actually breaks. When a bone breaks from a minor force that wouldn’t normally cause an injury—such as a fall from standing height or even a strong sneeze—it is called a fragility fracture [2][3].

In younger women, these fractures are the most significant symptom of underlying bone issues and should always be investigated by a doctor [4].

Recognizing Vertebral (Spinal) Fractures

While a broken wrist or hip is usually obvious, vertebral compression fractures (breaks in the bones of the spine) can be more difficult to identify. In the spine, the bone doesn’t “snap” like an arm bone; instead, it collapses or compresses [5].

Sudden vs. Silent Fractures

Spinal fractures in premenopausal women generally fall into two categories:

  • Acute (Sudden) Fractures: These often cause sudden, sharp, and severe back pain [6]. The pain is typically “focal,” meaning you can point to the exact spot on your spine that hurts [5]. It often gets worse when you stand or walk and may feel slightly better when you lie down.
  • Silent Fractures: Some vertebral fractures do not cause immediate, intense pain [5][7]. Instead, they may cause a dull ache, or no pain at all, and are only discovered during imaging for another reason [1].

Physical Changes to Watch For

Because these fractures can sometimes be silent, you should watch for these physical signs that your vertebrae may have compressed:

  • Height Loss: Unexplained height loss is a classic sign of multiple spinal fractures [8].
  • Postural Changes: You may notice a new curve in your upper back (sometimes called kyphosis) or a “stooped” appearance [5].
  • Abdominal Changes: As the spine shortens, the ribs move closer to the pelvis, which may cause the abdomen to protrude or create a feeling of fullness after eating small amounts.

Typical Aches vs. Fracture Pain

It is common to have back pain from muscle strain or “throwing your back out.” However, any new severe, focal, persistent, or unexplained back pain warrants clinical assessment rather than attempting to self-diagnose it. While typical back pain may improve with stretching and fracture pain is often felt directly on the bone (the midline of the back) [9][5], improvement with stretching does not rule out a fracture.

Urgent Warning Signs

Most osteoporotic fractures are not immediate medical emergencies, but they do require prompt evaluation to prevent further breaks. However, if a piece of the broken bone presses on a nerve or the spinal cord, it can cause serious complications [10].

Seek emergency medical care immediately for urgent evaluation and treatment if you experience:

  • New Weakness: Sudden difficulty walking or weakness in your legs or feet [10][11].
  • Numbness: A “pins and needles” feeling or loss of sensation in your legs, feet, or “saddle area” (the parts of your body that would touch a saddle) [12][13].
  • Loss of Control: Any new or sudden changes in your ability to control your bladder or bowels [12].
  • Radiating Pain: Severe pain that shoots down your legs or wraps around your torso like a tight band [10].

These symptoms require emergency assessment for conditions like spinal cord compression or cauda equina syndrome. Surgery may or may not be needed depending on the cause, but these symptoms cannot wait for a routine appointment [13][14].

Pregnancy and Postpartum Risks

Some premenopausal women experience a specific type of bone loss called Pregnancy- and Lactation-Associated Osteoporosis (PLO) [15]. This typically presents as severe back pain in the third trimester or shortly after giving birth while breastfeeding [6]. If you have significant back pain during this time, do not dismiss it as “normal pregnancy pain”; it is important to tell your doctor so they can check for fractures [16][17].

Common questions in this guide

What is a fragility fracture, and can a small movement cause one?
A fragility fracture is a break that happens after a minor force, such as a fall from standing height, a sneeze, or light lifting. In a premenopausal woman, it should be evaluated because it can be a sign of an underlying bone problem.
What are the warning signs of a spinal compression fracture?
A vertebral compression fracture may cause sudden, severe pain in one specific area of the back, often worse when standing or walking. It can also be silent, with little or no pain, and later show up as height loss, a new rounded upper back, or abdominal fullness.
How can I tell a muscle strain from a fracture in my back?
Muscle pain may improve with stretching, but new severe, focal, persistent, or unexplained back pain should be assessed by a clinician. Feeling better after stretching does not rule out a spinal fracture, so do not rely on self-diagnosis.
Which back-pain symptoms require emergency care?
Seek emergency care for new leg or foot weakness, numbness or pins and needles in the legs or the area that would touch a saddle, loss of bladder or bowel control, or severe pain that travels down the legs or wraps around the torso. These symptoms can signal pressure on the spinal cord or nerves and cannot wait for a routine appointment.
Can pregnancy or breastfeeding increase the risk of a spinal fracture?
Pregnancy- and lactation-associated osteoporosis is a form of bone loss that can occur during late pregnancy or soon after birth while breastfeeding. Significant back pain during these periods should not be dismissed as normal pregnancy pain; tell your doctor so a possible fracture can be assessed.
How are suspected spinal fractures checked?
Your clinician may choose an X-ray, MRI, or CT scan depending on your symptoms and whether the injury appears new. The appropriate test should be decided with a healthcare professional rather than by trying to diagnose the fracture yourself.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is the pain I am feeling consistent with a vertebral fracture, or does it seem more like a typical muscle or disc issue?
  2. 2.If we suspect a vertebral fracture, which imaging test (X-ray, MRI, or CT) is most appropriate to see if it is a new injury?
  3. 3.Have I lost any measurable height since my last physical exam?
  4. 4.Should I be screened for silent fractures if I have been on medications like steroids or have a history of missed periods?
  5. 5.How can I safely move or exercise if I currently have a vertebral fracture?

Questions For You

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References

References (17)
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    Analysis of Fracture Incidence in 135 Patients With Pregnancy and Lactation Osteoporosis (PLO).

    Miles B, Panchbhavi M, Mackey JD

    Cureus 2021; (13(10)):e19011 doi:10.7759/cureus.19011.

    PMID: 34824928
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    Premenopausal Osteoporosis.

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    PMID: 28131128
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    Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data.

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    BMC pregnancy and childbirth 2024; (24(1)):301 doi:10.1186/s12884-024-06520-0.

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    Maturitas 2020; (138()):14-25 doi:10.1016/j.maturitas.2020.05.004.

    PMID: 32631584
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    Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices.

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    Mayo Clinic proceedings 2024; (99(7)):1127-1141 doi:10.1016/j.mayocp.2024.01.011.

    PMID: 38960497
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    Teriparatide Treatment in Patients with Pregnancy- and Lactation-Associated Osteoporosis.

    Lampropoulou-Adamidou K, Trovas G, Triantafyllopoulos IK, et al.

    Calcified tissue international 2021; (109(5)):554-562 doi:10.1007/s00223-021-00871-y.

    PMID: 34132853
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    Vertebral compression fractures: Still an unpredictable aspect of osteoporosis

    Kutsal FY, Ergin Ergani GO

    Turkish journal of medical sciences 2021; (51(2)):393-399 doi:10.3906/sag-2005-315.

    PMID: 32967415
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    Minodronate for severe multiple vertebral fractures due to pregnancy- and lactation-associated osteoporosis: a case report and literature review.

    Ota K, Asanuma Y, Hirasawa H, et al.

    Therapeutic advances in musculoskeletal disease 2024; (16()):1759720X241259897 doi:10.1177/1759720X241259897.

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    Pregnancy-associated osteoporosis: a case-control study.

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    Aggressive epithelioid vertebral haemangioma with atypical imaging features presenting as compressive myelopathy: a case series.

    Castaño-Bustos D, Agudelo-Arrieta M, Ocampo-Navia MI, et al.

    Journal of surgical case reports 2026; (2026(4)):rjag135 doi:10.1093/jscr/rjag135.

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    Clinical evaluation, diagnosis, and decision-making for metastatic spine tumors: WFNS spine committee recommendations.

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    Multiple Myeloma Presenting as Cauda Equina Syndrome: A Rare and Early Spinal Manifestation.

    Choudhary L, Prakash V, Kantiwal P, et al.

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    Aggressive gastrointestinal stromal tumor with spinal metastases: a case report.

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    HR-pQCT reveals marked trabecular and cortical structural deficits in women with pregnancy and lactation-associated osteoporosis (PLO).

    Agarwal S, El-Najjar D, Kondapalli A, et al.

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    Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report.

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This page is for informational purposes only and does not constitute medical advice. A healthcare professional should evaluate new or severe back pain, and emergency symptoms need immediate care.

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