Kyphosis and incident falls among community-dwelling older adults

Abstract

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.

Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial

“…Observational data have shown that hyperkyphosis is associated with impaired physical function [5, 6, 8, 9, 43, 44]. Moreover, in our earlier pilot trial [17], we reported improvements in physical function in the modified PPT among treated participants.…”

“…Kyphosis tends to progress with age [2, 4] and is associated with significant health impairments. Kyphosis greater than 40° is commonly defined as hyperkyphosis [1, 2], and once kyphosis progresses beyond 50°, the risk for falls [5, 6] and fractures [7] is increased. Multiple studies have reported that older persons with hyperkyphosis suffer from poor and worsening health-related quality of life (HRQoL) [1] and physical function [2, 8–10].…”

Cervical Spine Hyperextension and Altered Posturo-Respiratory Coupling in Patients With Obstructive Sleep Apnea Syndrome

“…Conversely we observed a compensatory thoracic hyperkyphosis (24,29). This compensation probably limits the disturbance of balance secondary to pathological spinal alignment (35), but may increase the risk of falls and others hyperkyphosisrelated comorbidities (46). Moreover, the change in head rotation may theoretically cause disturbances of balance by perturbing central processing of visual and vestibular afferents (47).…”

Spinal postural alignment measurements using markerless digital photography

“…1,2 Hyperkyphosis leads to worsened gait patterns and balance, lowers Activity of Daily Living (ADL), and causes a decline in lung function. [3][4][5][6] Given that age-related spinal postural alignment abnormalities, including hyperkyphosis, progress temporally, it is important to measure the posture repeatedly and provide preventive and appropriate intervention guidance. In Japan, the aging population is increasing rapidly, and extending healthy life expectancy is important.…”

“…However, it is not possible to identify slight changes in the subject's posture because of the number of 1.7 cm blocks. 4,12 Therefore, we have devised a method to measure the spinal postural alignment using image processing software with ImageJ (version 1.52, National Institutes of Health, Bethesda, Maryland, USA). A posture measurement method using digital images has already been reported, but it is unsuitable for use in the community because it requires exposure of the skin to expose the landmarks.…”