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kyphosis (hyperkyphosis, Dowager's hump)

A deformity of the spine characterized by extensive flexion (hump back). Etiology: - vertebral fractures (37%) <osteoporosis> - postural changes a) cervical lordosis & lumbar lordosis b) inability to correct posture to an erect stance - degenerative disk disease - muscle weakness, back muscles & muscles of upper extremities - loss of intervertebral ligament elasticity - genetic factors Epidemiology: - affects 20-40% elderly Special laboratory: - pulmonary function test to evaluate dyspnea Radiology: - bone mineral density (DEXA) with vertebral fracture assessment [3] - radiography of lumbar spine & thoracic spine to assess for vertebral fracture - pathologic fracture makes diagnosis of osteoporosis [3] Complications: - impaired pulmonary function - restrictive lung disease - decreases mobility of the chest wall & restricts lung expansion - diminished physical function - falls in the elderly - fractures, associated with osteoporosis - increased mortality Management: - treat osteoporosis - hormone replacement therapy may prevent age-related hyperkyphosis [4] - spinal orthoses - back strengthening exercises - kyphoplasty & vertebroplasty may help painful fractures & improve function - non-invasive positive pressure ventilation - BiPAP for atelectasis from hypoventilation due chest wall restriction from kyphosis

Related

scoliosis

Specific

kyphoscoliosis

General

abnormal curvature of the spine

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Kado DM et al, Hyperkyphosis in older persons. Ann Intern Med 2007, 147:330 PMID: 17785488
  3. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Woods GN, Huang MH, Cawthon PM et al. Patterns of menopausal hormone therapy use and hyperkyphosis in older women. Menopause. 2018 Jul;25(7):738-743. PMID: 29462096 https://insights.ovid.com/crossref?an=00042192-201807000-00006
  5. Koele MC, Lems WF, Willems HC. The clinical relevance of hyperkyphosis: a narrative review. Front Endocrinol (Lausanne). 2020;11:5 PMID: 32038498 PMCID: PMC6993454 Free PMC article https://www.frontiersin.org/articles/10.3389/fendo.2020.00005/full
  6. Lorbergs AL, O'Connor GT, Zhou Y et al. Severity of kyphosis and decline in lung function: the Framingham Study. J Gerontol A Biol Sci Med Sci. 2017;72(5):689-694 PMID: 27341855 PMCID: PMC5964740 Free PMC article https://academic.oup.com/biomedgerontology/article/72/5/689/2629944