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Elderly
women with 'dowager's hump' may be at higher
risk of earlier death
Hyperkyphosis, or "dowager's hump" — the
exaggerated forward curvature of the upper
spine seen commonly in elderly women — may
predict earlier death in women whether or
not they have vertebral osteoporosis, UCLA
researchers have found.
In a study published in the May 19 issue of
Annals of Internal Medicine, researchers
found that older white women with both
vertebral fractures and the increased spinal
curvature that results in the bent-over
posture characteristic of hyperkyphosis had
an elevated risk for earlier death.
The finding was independent of other factors
that included age and underlying spinal
osteoporosis.
Women who had only hyperkyphosis, without
vertebral fractures, did not show an
increased risk for premature death.
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," said Dr. Deborah Kado, an
associate professor of orthopedic surgery
and medicine at the David Geffen School of
Medicine at UCLA and the study's primary
investigator.
"We demonstrated that having this
age-related postural change is not a good
thing. It could mean you're likely to die
sooner."
For the study, the researchers reviewed data
on 610 women, age 67 to 93, from a cohort of
9,704 participants in the Study of
Osteoporotic Fractures. The participants
were recruited between 1986 and 1988 in
Baltimore, Md.; Minneapolis, Minn.;
Portland, Ore.; and Pennsylvania's
Monongahela Valley.
Researchers
measured spinal curvature with a flexicurve
and assessed vertebral fractures from spinal
radiographs; they assessed mortality based
on follow-ups averaging 13.5 years.
Adjusting for age, as well as
osteoporosis-related factors such as low
bone density, moderate and severe vertebral
fractures, and the number of prevalent
vertebral fractures, the researchers found
that women with previous vertebral fractures
and increasing degrees of spinal curvature
were at increased mortality risk from the
spinal condition, regardless of age,
smoking, spinal bone-mineral density, or the
number and severity of their spinal
fractures.
These study findings provide evidence that
it is not just vertebral fracture alone but
the associated increased spinal curvature
that may be most predictive of adverse
health outcomes.
Other studies linking hyperkyphosis to poor
health, such as impaired physical function,
increased fall risk, fractures and
mortality, have been unable to exclude the
possibility that vertebral fractures alone
were the underlying explanation for the
findings.
The researchers note several caveats. This
study focused on women, though hyperkyphosis
also affects men; 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 disease; and the timing of
the assessments could have affected the
results, though it's unlikely to have made
much difference.
However, this study demonstrates a possible
association between hyperkyphosis and
increased risk for earlier death independent
of the number and severity of vertebral
fractures or osteoporosis in older women,
the researchers write.
"These results add to the growing literature
that suggests that hyperkyphosis is a
clinically important finding.
"Because
it is readily observed and is associated
with ill health in older persons,
hyperkyphosis should be recognized as a
geriatric syndrome — a 'multifactorial
health condition that occurs when the
accumulated effect of impairments in
multiple systems renders a person vulnerable
to situational challenges.'"
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