Age-related Hyperkyphosis

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Search Strategy

The information you will find below is based on articles found on PubMed by using the keywords: age-related hyperkyphosis, hyperkyphotic posture, elderly hyperkyphosis, rehabilitation hyperkyphosis.

Definition/Description^1,2

An age-related hyperkyphosis can be described as an exaggerated dorsal curvature of the thoracic spine. It can lead to mobility impairments (such as decreased mobility), and it increases the risks of falling and of fractures. A thoracic hyperkyphosis is associated with advancing age, low bone density, muscle weakness and degenerative disk diseases. An age-related hyperkyphosis can have an impact on the basic functioning and daily living (especially performance of mobility tasks). That’s why its diagnostic is important, research of the risk factors, the possible consequences and surely its treatment/rehab.

Clinically Relevant Anatomy^1,2

As thoracic kyphosis increases, there are also changes in the normal sagittal plane alignment that may cause pain and risk of dysfunction in the shoulder and pelvic girdle and over the entire length of the spine. Forward head posture, scapula protraction, reduced lumbar lordosis, and decreased standing height are often associated with hyperkyphosis. The result of these postural changes is the flexion bias around the hip and shoulder joints that increases and can interfere with normal joint mechanics and movement patterns.

Epidemiology /Etiology^1,2,3

Hyperkyphosis is a widely recognized condition and it commonly affects the elderly population. Current studies estimate its prevalence among older adults at 20% to 40% ²

A lot of factors can increase de risk of having an age-related hyperkyphosis:¹
• Vertebral fractures: the bone mineral density decrease with the age. It’s the most notable cause but it may explain only about 42-48% of the hyperkyphosis variance. It has been shown that 2/3 from those with an accentuated hyperkyphosis had no underlying fracture.³
• Osteoporosis
• Degenerative disc disease
• Muscle weakness: most of studies confirm its related with spinal extensor muscle weakness.
• Decreased mobility: decrease of spinal extension by aging
• Sensory deficits: a loss of postural control because of a deficit in the somatosensory, vestibular, visual system ( occurring by aging)
• Poor habitual posture 
• Ligament degeneration²
All these factors occur with aging.

Characteristics/Clinical Presentation^1,3,5

In most cases the hyperkyphosis is gradual over time and you may not have recognized it.
But in case of a sudden increased kyphosis there could be more severe causes and health problems.
When hyperkyphosis is present, people could have difficulties with

• Getting up from a chair, out of bed, or out of the bathtub
• Walking (more slowly)
• Feeling "off-balance," and/or losing your balance, or almost falling
• Feeling more tired than usual (fatigue)
• Breathing (in more severe cases)
  

Diagnostic Procedures¹

Nowadays we have different reliable methods helping us to diagnose an hyperkphosis. The gold-standard orthopedic technique for assessment of thoracic kyphosis is standing lateral spine radiographs. The Cobb’s angle of kyphosis is calculated from perpendicular lines drawn on a standard thoracic spine radiograph: a line extends through the superior endplate of the vertebral body, marking the beginning of the thoracic curve (usually at T4), and the inferior endplate of the vertebral body, marking the end of the thoracic curve (usually at T12). While this method is the gold-standard, it is limited by the need for radiography.
Other acceptable ways to diagnose a hyperkyphosis are the Debrunner kyphometer and the flexicurve ruler.

Outcome Measures

We talk about an hyperkyphosis when the angle in the anterior curvature of the thoracic spine is greater than 40°. After the age of 40, the angle begins to increase. This increase happens more rapidly to women, than to men. The mean angle in women from 55 to 60 year old is 43°. At the age of 76 to 80, the mean angle becomes 52°. Reports of prevalence and incidence of hyperkyphosis in older adults vary from approximately 20% to 40% among both men and women. As kyphosis angle increases, physical performance and quality of life often declines, making early intervention for hyperkyphosis a priority.¹

Examination

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Medical Management

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Physical Therapy Management ^1,4,5

Every case of hyperkyphosis is different. Here is a variety of treatment options:
Many men and women with prevalent hyperkyphosis are treated with osteoporosis antiresorptive or bone-building medications because they have low bone density or spine fractures.

• Specific exercises to help reduce the kyphotic posture
• Postural alignment training, stretching, and strengthening exercises to help reduce the curvature and prevent the condition from advancing.
• Breathing exercises to help improve the tolerance for physical activity by increasing your lung capacity.
• Pain management using modalities such as warmth, cryotherapy, and/or transcutaneous electrical nerve stimulation (TENS). Your physical therapist will help to choose what modality would be most helpful for you.
• Myofascial/soft tissue manual therapy and shoulder mobilization to help improve spinal flexibility.
• Specialized braces or therapeutic taping to help reduce the angle of the curve.
• Education to improve your activities of daily living and ease your physical functioning. The physical therapist will teach you how to move safe and correctly.
• Balance exercises and walking (gait) training to increase your tolerance of activity and improve your safety by reducing your risk of falls.
  

Mortality

Several studies demonstrated a graded association between hyperkyphosis and an increased risk of early mortality. Women who had both, underlying fractures AND hyperkyphosis had a greater risk of mortality compared to women with only underlying fractures or hyperkyphosis. ³

Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

{1} Wendy B. Katzman, Age-related hyperkyphosis: its causes, management, and consequences. J orthop Sports Phys Ther, June 2010, 40(6): 352-360
Level of evidence: 5
{2} Kado DM et al, Narrative review: hyperkyphosis in older persons, Ann Intern Med, September 2007, 147(5):330-8
Level of evidence : secundair evidence
{3} DM Kado, the rehabilitation of hyperkyphotic posture in the elderly, Eur J Phys Rehab Med, 2009, 45:583-93
Level of evidence: 2A
{4}Deborah M. Kado, Mei-Hua Huang, Claude B. Nguyen, Elizabeth Barrett-Connor and Gail A. Greendale: Hyperkyphotic Posture and Risk of Injurious Falls in Older Persons. Suite 2339, Los Angeles, CA 900
Level of evidence: 2B
{5}Deborah M. Kado, MD, MS; Li-Yung Lui, MA, MS; Kristine E. Ensrud, MD, MPH; Howard A. Fink, MD, MPH; Arun S. Karlamangla, PhD, MD; Steven R. Cummings, MD: Hyperkyphosis Predicts Mortality Independent of Vertebral Osteoporosis in Older Women. Ann Intern Med. 2009;150(10):681-687. doi:10.7326/0003-4819-150-10-200905190-00005
Level of evidence: 1B