Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study

Willems, Hanna C.; Groot, Maartje H. de; Campen, Jos P. C. M. van; Lamoth, Claudine J. C.; Lems, Willem F.

doi:10.1186/s12877-015-0018-z

Cited by 65 publications

(68 citation statements)

References 36 publications

(42 reference statements)

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“…The main findings of our study are in line with the only other prospective published report of kyphosis and falls [26], although poor participant retention limited the conclusiveness of the previous study's results. One large cross-sectional study found an association between the blocks measure and selfreported falls in the previous year among men only, though the authors noted that they lacked power to detect a significant association in women [17].…”

Section: Discussionsupporting

confidence: 87%

Kyphosis and incident falls among community-dwelling older adults

et al. 2017

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Summary Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits. Introduction To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Methods Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview. Results Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. Conclusions Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

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Section: Discussionsupporting

confidence: 87%

Kyphosis and incident falls among community-dwelling older adults

et al. 2017

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“…According to Kado [15], the relationship between thoracic hyperkyphosis and falls in women could be explained by age. In the study by Van der Jagt-Willems et al [27], patients with hyperkyphosis were twice more likely to fall than their counterparts, regardless of sex. In contrast, Kasukawa et al [21] and Ishikawa, Miyakoshi et al [22] found no correlation between falls and increased thoracic hyperkyphosis.…”

Section: Resultsmentioning

confidence: 89%

“…The following methods and tools were used to assess body posture: SpinalMouse [8, 21 -24], occiput-to-wall distance (OWD) [25 -27], method using 1.7 cm blocks [28], flexicurve ruler [29,30], Cobb angle [24,26,27], photogrammetry/Moiré method [31], method with photographic recording [32] and digital inclinometer [33]. Foot posture was assessed using the Foot Posture Index (FPI) [34,35], which tests foot characteristics across six domains: foot posture, foot deformity and lesions, plantar tactile sensation, toe muscle strength and foot pain, and a three-dimensional foot scanner (Footstep PRO, Dream GP Company, Japan) [36].…”

Section: Resultsmentioning

confidence: 99%

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Postural changes versus balance control and falls in community-living older adults: a systematic review

et al. 2018

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Introduction: Since falls are considered to be a public health problem, it is important to identify whether postural changes over time contribute to the risk of falls in older adults. Objective: To investigate whether postural changes increase fall risk and/or postural imbalance in healthy, community-dwelling older adults. Methods: In April 2016, two reviewers independently searched the PubMed, Web of Science, SPORTDiscus, and CINAHL databases for studies in English published in the previous 10 years, using the following combined keywords: "posture" or ("kyphosis","lumbar lordosis","flexed posture","spinal curvature","spinal sagittal contour") AND "elderly" AND "fall". Study quality was assessed according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies. Results: The search retrieved 1,734 articles. Only observational studies that assessed posture, balance, and/or falls in older adults were considered eligible for review. The final sample included 17 articles: reliability and reproducibility of the instruments were not reported in five studies, while two studies offered a questionable description of the instruments used. Fourteen

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“…Gentle percussion over the spinous processes with a closed fist is likely to induce pain in recent vertebral fractures, but not in individuals with degenerative change without fracture [35]. In contrast, kyphosis measured by several techniques, such as wall-to-occiput distance, or wall-to-tragus distance have shown contradictory results [7,33,36,37]. Kyphosis often results from degenerative disc disease rather than vertebral fracture [38].…”

Section: Who To Image? Physical Examination (See Box 1)mentioning

confidence: 99%

Spinal radiographs in those with back pain—when are they appropriate to diagnose vertebral fractures?

2017

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms The presence of an osteoporotic vertebral fracture improves fracture risk assessment and may change management, so it is vital for healthcare professionals to assess patients for the presence or absence of these fractures. This may be particularly important in the presence of back pain. However, the correlation between low back symptoms and spinal imaging results is poor and the pathophysiology of most low back pain is not known, leading to a common conclusion that spinal radiographs are not appropriate for the assessment of back pain. For individual patients with back pain, spinal radiographs should be considered if they have certain features in the history and examination. As well as the traditional risk factors for osteoporosis, self-reported descriptives of back pain and novel physical examination findings have been shown to make the presence of vertebral fractures more likely. Systematic approaches have the potential to improve bone health across the population, but need to be targeted to be cost-effective. KeywordsVertebral fracture Back pain Pain descriptives Physical examinationMini Abstract (50 words)Spinal radiographs should be considered for individual older patients with back pain if they have certain additional features in the history and examination.

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Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study

Cited by 65 publications

References 36 publications

Kyphosis and incident falls among community-dwelling older adults

Kyphosis and incident falls among community-dwelling older adults

Postural changes versus balance control and falls in community-living older adults: a systematic review

Spinal radiographs in those with back pain—when are they appropriate to diagnose vertebral fractures?

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