Two-thirds. That's the share of people with spinal compression fractures who have no obvious symptoms, according to a review in American Family Physician (AFP). A compression fracture happens when a vertebra is squeezed from above and below and collapses flat. Yet many pass without pain and are found by chance on an X-ray taken for another reason. If your parent's back has started to look noticeably rounded lately, or they mention they've gotten shorter, take a look at a few numbers before writing it off as just age.

Fractures that happen quietly

With osteoporosis, bones can give way under very little force. No major accident is needed. A minor fall, reaching out, twisting, coughing or sneezing, or lifting something can be enough to collapse a vertebra.

The AFP review notes that more than two-thirds of people with spinal compression fractures have no symptoms and are diagnosed incidentally. The American Academy of Orthopaedic Surgeons (AAOS) explains that about 1.5 million of these spinal fractures occur every year in the U.S. alone. That figure can't be compared directly with other countries, but one thing is clear: these fractures are common, and they often go unnoticed.

That's why assuming "they haven't said it hurts, so they're fine" is risky. Posture often shows the problem before pain does. Height shrinks, and the back curves forward.

One fracture invites the next

The most sobering number with compression fractures is the "next fracture." According to the AFP review, people who have had a spinal compression fracture face about 5 times the risk of another spinal fracture and 2 to 3 times the risk of fractures elsewhere.

And it happens fast. AAOS notes that more than 30% of people with a spinal fracture have another fracture within a year. That's more than three in ten, within one year.

When fractures pile up across several vertebrae, the back can curve significantly. The Royal Osteoporosis Society (ROS) explains that this kind of curvature can cause shortness of breath or a bloated feeling from pressure on the abdomen. A rounded back isn't just about appearance. It can affect breathing, digestion, and daily activities.

The numbers in Korea: only half go on to treatment

There's data from Korea, too. Researchers from the National Health Insurance Service and the Korean Society for Bone and Mineral Research analyzed health insurance records for people aged 50 and older and published the results in the Journal of Bone Metabolism in 2025. The share who were prescribed osteoporosis medication within a year of an osteoporosis-related fracture varied by site, and spinal fractures had the highest rate, at about 52%.

The highest rate is barely half. Put another way, close to half of people who had a spinal fracture had no record of an osteoporosis prescription even a year later. Some of them may not have needed medication, but it suggests that care after a fracture breaks off more often than you might think.

That's why the order of steps matters. If you suspect a fracture, see a doctor first. Imaging confirms whether there's a fracture, and a bone density test (DXA) assesses how severe the osteoporosis is. Whether medication or a procedure is needed should be decided with a specialist. Just as important as the fracture itself is whether follow-up care continues afterward.

• New back pain that started suddenly
• Pain when moving or changing position that eases when lying down
• Back pain that gets worse when coughing or sneezing
• Loss of height compared with the past
• A back that seems to curve further forward over time
• Long-term use of steroid (corticosteroid) medication, or a previous fracture

A home that prevents falls, a body that moves again

The WHO reports that falls kill about 684,000 people worldwide every year, making them the second leading cause of unintentional injury death after road traffic injuries. Adults over 60 suffer the most fatal falls. For older adults with osteoporosis, preventing falls means preventing fractures.

The fall-prevention measures the WHO highlights for older adults include gait, balance, and functional training; tai chi; checking and modifying the home; reducing or stopping certain psychotropic medications; and vitamin D supplements for those who are deficient.

After a fracture diagnosis, the ROS says healing takes roughly 6 to 12 weeks. During this time, avoid lifting heavy objects or straining while bent forward. But staying in bed all the time weakens muscles and bones further. Moving early, within what you can tolerate, is recommended, and your care team decides the exact limits. The AFP review explains that strengthening the back muscles (spinal extensors) can improve strength and bone density and help lower the risk of future fractures.

If you're considering manual therapy or spinal adjustments, a medical evaluation comes first. From a chiropractic perspective as well, the basic principle is to adapt technique and force appropriately when osteoporosis is present.

• Make sure living room and hallway floors are free of clutter and cords that could trip someone
• Remove slippery rugs and mats or add non-slip backing
• Install grab bars and non-slip mats in the bathroom and toilet
• Keep night lights on along the path to the bathroom
• Mark door thresholds and step edges brightly so they're easy to see
• Keep frequently used items at a height that doesn't require bending over or standing on tiptoe
• Ask the doctor whether any current medications can cause dizziness

See a doctor first if…

• New leg weakness, numbness, or changes in sensation
• Difficulty passing urine or stool, or loss of bladder or bowel control
• Back pain severe enough to make moving hard after a fall or a knock
• Severe pain that doesn't improve with rest or lying down, or pain that's worse at night
• Unexplained weight loss or fever along with the pain
• New or worsening shortness of breath

If even one of these symptoms is present, don't wait. Seek medical care right away. These situations call for an evaluation of possible nerve compression or other conditions.

This weekend, measure your parent's height. If it's noticeably shorter than the height they remember from their younger years, be sure to mention that number at their next doctor's visit.

This article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.