Vertebral compression fracture – Approximately 4 percent of patients presenting in the primary care setting with low back pain will have a vertebral compression fracture [19]. While some produce no symptoms, other patients present with acute onset of localized back pain which may be incapacitating. There may be no history of preceding trauma. Risk factors for osteoporotic fracture include advanced age and chronic glucocorticoid use (table 3). A history of an osteoporotic fracture is a risk factor for subsequent fractures, which can be mitigated by pharmacologic therapy. (See "Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment", section on Clinical manifestations' and "Osteoporotic fracture risk assessment" and "Overview of the management of osteoporosis in postmenopausal women", section on 'Postfracture'.)