A patient with osteoporosis presents with sudden or gradual back pain and loss of height in the affected vertebral body. What is the most likely diagnosis?

• A. Compression fracture of the vertebral body
• B. Scoliosis progression
• C. Disc herniation
• D. Osteomyelitis of the vertebra

Answer: (A)

Osteoporosis weakens the vertebral bodies, making them susceptible to fracture from normal axial loading. A compression fracture of a vertebral body is the classic cause of back pain that can be sudden or gradual, with a loss of height in the affected vertebra and often a kyphotic deformity. In osteoporosis, the anterior two-thirds or the entire vertebral body can collapse, producing a wedge shape and measurable height loss on imaging. This pattern distinguishes it from other spine issues: scoliosis progression is a lateral curvature that develops over time and doesn’t typically cause acute vertebral height loss; disc herniation causes nerve-root–type radicular pain rather than focal vertebral collapse; osteomyelitis presents with fever, systemic symptoms, and infection signs with possible vertebral destruction rather than isolated height loss. Therefore, the most likely diagnosis is a compression fracture of the vertebral body due to osteoporosis.