Elderly women with hyperkyphosis may be at higher risk of earlier death

Hyperkyphosis, also known as “dowager’s hump," could be a risk factor for earlier death in women regardless of whether they have vertebral osteoporosis.

In a study published in the May 19 issue of Annals of Internal Medicine, researchers from the University of California, Los Angeles (UCLA) found that older white women with both vertebral fractures and the increased spinal curvature that results in the bent-over posture characteristic of hyperkyphosis demonstrated an elevated risk for earlier death. The finding was independent of other factors that included age and underlying spinal osteoporosis, according to a UCLA press release.

Women who had only hyperkyphosis without vertebral fractures did not show an increased risk for premature death, the investigators said in the news release.

Hyperkyphosis can be caused by a number of factors besides osteoporosis, including habitual poor posture and degenerative diseases of the muscles and intervertebral discs.

“Just being bent forward may be an important clinical finding that should serve as a trigger to seek medical evaluation for possible spinal osteoporosis, as vertebral fractures more often than not are a silent disease,” primary investigator Deborah M. Kado, MD, MS, associate professor of orthopedic surgery and medicine at the David Geffen School of Medicine at UCLA, said in the press release. “We demonstrated that having this age-related postural change is not a good thing. It could mean you’re likely to die sooner.”

In the Study of Osteoporotic Fractures funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging, the investigators reviewed data on 610 women, aged 67 to 93 years, from a cohort of 9,704 participants. Researchers measured spinal curvature with a flexicurve and assessed vertebral fractures from spinal radiographs. They also assessed mortality based on follow-ups averaging 13.5 years, according to the news release.

The investigators found that women with previous vertebral fractures and increasing degrees of spinal curvature were at increased mortality risk from hyperkyphosis regardless of age, smoking, spinal bone-mineral density or the number and severity of their spinal fractures. This was evident even after adjusting for age and osteoporosis-related factors such as low bone density, moderate and severe vertebral fractures, and the number of prevalent vertebral fractures, Kado said in the release.

These study findings offer evidence that it is not just vertebral fracture alone but the associated increased spinal curvature that may be most predictive of adverse health outcomes, she noted.

“These results add to the growing literature that suggests that hyperkyphosis is a clinically important finding,” Kado said in the press release.

She acknowledged that the study only focused on white women, and measurements for vertebral fractures were based only on height ratios, which could lead to misclassification of other causes of height ratio decreases, such as Scheuermann’s disease.

Reference:
Kado DM, Lui L-Y, Ensrud KE, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 150;10:681-687.