Vertebral compression fractures: differentiation between benign and malignant causes.

Attempting to ascertain the underlying cause of a vertebral compression deformity may present a difficult diagnostic dilemma (Figure 1). The spine is a common site of metastatic disease accounting for thirty to fifty-five percent of all bony metastases. If there is sufficient tumor osteolysis, a pathological fracture will occur. However, progressive softening of the vertebrae in post-menopausal women is also very common. Spontaneous compression fractures secondary to osteoporosis often result and may be indistinguishable from those of malignant origin. Benign metabolic processes such as hypothyroidism, hyperparathyroidism, Paget's disease, and others may result in Figure 2 Lateral radiograph of a thirty-five year old female undergoing chemotherapy and systemic steroid therapy for metastatic breast cancer with hypercalcemia. There is diffuse osteoporosis with multiple compression fractures of the superior vertebral endplates. Magnetic resonance scanning showed no evidence of bony metastases.