Factors associated with kyphosis progression in older women: 15 years' experience in the study of osteoporotic fractures

Abstract

Age-related hyperkyphosis is thought to be a result of underlying vertebral fractures, but studies suggest that among the most hyperkyphotic women, only one in three have underlying radiographic vertebral fractures. Although commonly observed, there is no widely accepted definition of hyperkyphosis in older persons, and other than vertebral fracture, no major causes have been identified. To identify important correlates of kyphosis and risk factors for its progression over time, we conducted a 15 year retrospective cohort study of 1,196 women, aged 65 years and older at baseline (1986–88), from four communities across the United States: Baltimore County, MD; Minneapolis, MN, Portland, Oregon, and the Monongahela Valley, PA. Cobb angle kyphosis was measured from radiographs obtained at baseline and an average of 3.7 and 15 years later. Repeated measures, mixed effects analyses were performed. At baseline, the mean kyphosis angle was 44.7 degrees (standard error 0.4, standard deviation 11.9) and significant correlates included a family history of hyperkyphosis, prevalent vertebral fracture, low bone mineral density, greater body weight, degenerative disc disease, and smoking. Over an average of 15 years, the mean increase in kyphosis was 7.1 degrees (standard error 0.25). Independent determinants of greater kyphosis progression were prevalent and incident vertebral fractures, low bone mineral density and concurrent bone density loss, low body weight, and concurrent weight loss. Thus, age-related kyphosis progression may be best prevented by slowing bone density loss and avoiding weight loss.

Postural alignment of patients with Chronic Obstructive Pulmonary Disease

“…Usually, thoracic kyphosis undergoes changes with aging, as it is often related to aspects such as, osteoporosis, obesity, sedentary lifestyle and muscular weakness (22,23,24,25), which are commonly observed in elderly individuals.…”

Epidemiology of Vertebral Fractures

“…Radiographically, more severe vertebral fractures are associated with more pain and disability compared with milder ones (181) and are more likely to be clinically recognized at the time of their occurrence (2). Although vertebral fractures cause only a modest proportion of the kyphosis that develops with increasing age (182), incident vertebral fractures are associated with progression of kyphosis (183,184), which in turn is associated with reduced pulmonary function (185e187), gastroesophageal reflux disease (188), reduced physical function (189e191), and possibly falls (192,193). Radiographic vertebral fractures that were not recognized at the time of their occurrence are not necessarily asymptomatic.…”

Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a Randomized Controlled Trial of Multimodal Spine-Strengthening Exercise in Older Adults With Hyperkyphosis

“…2,[4][5][6][7][8] Risk factors for hyperkyphosis include advanced age, low bone mass, degenerative disc disease, and prevalent vertebral fractures. [9][10][11] Furthermore, routine poor posture, decreased spinal extension mobility, and reduced back extensor muscle strength are other commonly cited potential causes of age-related hyperkyphosis, [12][13][14] and these impairments may be modifiable with exercise.…”