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Older Adults: Here's What Causes Hunchback – and How to Prevent It

US News & World Report - Health logo US News & World Report - Health 8/17/2018 K. Aleisha Fetters
An active healthy senior man with a hunch back (poor posture) playing tennis.: In recent decades, kyphosis has become a significant health problem for older men and women alike. © (Getty Images) In recent decades, kyphosis has become a significant health problem for older men and women alike.

Kyphosis, a painful condition commonly known as "hunchback" is a physical deformation of the middle and upper spine, in which its natural curve increases, resulting in a "hunched over" posture.

While the postural issue used to be a problem largely reserved for older women, in recent decades, kyphosis has become a significant health problem for older men and women alike, says Dr. Alpesh Patel, director of orthopaedic spine surgery at Northwestern Memorial Hospital.

"Twenty years ago, when I was in medical school, no one ever thought about it," he says. Kyphosis now affects between 20 and 40 percent of adults, with both prevalence and severity increasing through the decades, according to a 2015 study published in the scientific journal Neurosurgery. The effects of kyphosis range from decreased mobility to pain and disability to impaired lung function and even increased mortality, according to the study's findings.

So why is kyphosis becoming increasingly common? In a word: weakness.

"Osteoporosis is the leading cause of age-related kyphosis, with sarcopenia, or age-related muscle loss, being a secondary cause," Patel explains. Much of the osteoporosis prevalence in women is related to menopausal hormone changes. However, as the average American's life has become more sedentary and desk jobs have replaced physically laborious ones, the rates of osteoporosis have grown in women and men. Patel notes that the body's peak bone mass occurs in the 30s and early 40s, and then naturally declines thereafter.

As the spine – and the muscles that support it – become weaker, the vertebrae become susceptible to compression fractures, in which the bone breaks under the load of everyday activities like walking or even coughing, he says. An estimated 1.5 million vertebral compression fractures, or VCFs, occur every year in the United States, affecting about 25 percent of postmenopausal women, according to 2012 research published in The Permanente Journal. These compression fractures are about half as common in men as they are in women; when they occur, the bone typically slides down the spine and, over time, can form the thoracic spine into a C-shape.

"The best way to avoid compression fractures and kyphosis is to prevent or slow the development of osteoporosis," says Dr. Andrew Sama, a spine surgeon at the Hospital for Special Surgery in New York City.

Below, spinal experts share their strategies to help keep the body's bones – especially those along the spine – strong.

Measure your bone density. To best address your vertebral bone health, you need to know its status. Two common tests to measure bone density are dual-energy x-ray absorptiometry, also called DEXA, and quantitative CT, or QCT, Sama says.

Both tests are noninvasive and scan the spine (and often the hips) to determine bone mineral density. DEXA is often contraindicated in anyone with arthritis, scoliosis, disc space narrowing, spinal degenerative diseases, obesity and other conditions, according to the department of radiology and biomedical imaging at the University of California–San Francisco. Talk to your primary care doctor to determine which test is right for you.

Perform weight-bearing exercises. "Bones are alive and constantly turning over and remodeling themselves," Patel says. One trigger for your bones to grow stronger is to regularly stress them.

The best forms of exercising to increase bone strength include weight-bearing exercises, specifically exercises that load the body axially, or with force being exerted through the spine, says Ryan Campbell, a training specialist at Anytime Fitness of Southern Wisconsin. Examples of axial loading exercises include dead lifts, barbell back and front squats and overhead dumbbell presses. Prioritize using resistance levels that allow you to perform three sets of 10 reps of each exercise with proper form, he says, noting that lighter loads will have less effect on bone growth.

However, for those whose bone mineral density scans point to osteoporosis or osteopenia, it may be advised to trade exercises that put downward pressure on the spine for gentler ones. While stressing the spine stimulates vertebral bone growth, the amount of that stress must match the current strength of the spine, Patel says.

If your doctor has not given you specific recommendations on what exercises are contraindicated, according to your bone health, talk to a physical therapist or certified trainer before beginning an exercise routine, Campbell advises.

Review your current prescriptions. "Medications, including steroids, proton pump inhibitors to treat gastroesophageal reflux, and some antidepressive medications can increase risk of osteoporosis," Sama says. Talk to your doctor about the impact any prescribed medications could have on your spinal health. In some cases, alternative medications may be available.

It's worth noting that medications can also be used to help slow the progression of osteoporosis. Common options include bisphosphonates, teriparatide, abaloparatide and denosumab, Sama says.

Assess your calcium and vitamin D levels. Both nutrients are vital to bone health, but many people don't get enough of calcium or vitamin D. While a basic metabolic panel, which is a standard part of annual physicals, includes calcium testing, it does not include vitamin D screening, according to the American Association for Clinical Chemistry. You must request a vitamin D test – performed through a simple blood draw – to have your levels evaluated.

Once you know your calcium and vitamin D levels, you and your doctor can discuss any nutrition or lifestyle changes, as well as supplementation and dosage if necessary, Sama says.

Pay attention to protein. While most people think about protein in terms of strengthening the muscles, increased muscle health can indirectly improve bone strength. According to a 2014 study published in Current Opinions of Clinical Metabolic Care, protein may also promote strong bones by increasing calcium absorption and affecting hormone levels.

However, recent research shows that older Americans aren't getting enough of this important nutrient to effectively maintain muscle health. One study, presented at the American Society for Parenteral and Enteral Nutrition 2018 Nutrition Science & Practice Conference, shows that roughly 40 percent of older adults don't meet current the daily protein recommendation of 0.8 grams of protein per kilogram of a person's body mass per day. That equals about 0.36 grams of daily protein per pound of body weight. However, mounting research advises older adults to eat about double the current recommended amount.

Strengthen the core and the back. It's important to strengthen the core muscles' ability to stabilize and protect the spine and the back muscles' capability to pull the shoulders and spine into upright posture, Patel says. Rowing exercises, including resistance-band rows and lat pull-downs, can help strengthen the muscles of the middle and upper back. Supine Y raises (in which you lie on the floor and raise your outstretched arms from the floor to form a Y with your body) and resistance-band pull-aparts, where you hold two ends of a resistance band with your arms in front of your shoulders and pinch your shoulder blades together, focus on the muscles of the upper back.

Meanwhile, dead-bugs and bird-dogs train the deep-lying muscles of the core to stabilize the spine. Pallof presses, in which you stand perpendicular to a resistance band or cable's fixed point and hold the handle in front of your abdomen and press forward, further improve the ability of the core muscles to act as a sort of protective spine scaffolding, Sama says.

Avoid spinal flexion. If you're diagnosed with osteopenia or osteoporosis, it's smart to lessen or avoid activities that include spinal flexion or bending and can increase pressure on the vertebra and spinal discs, Sama says. These activities include both exercises such as crunches, toe touches and trunk twists, as well as acts of daily living such as slouching in front of a computer, he says.

Focus on maintaining a long, neutral spine, with only a slight curve in both your lower and upper back, throughout the day, Patel recommends.

Avoid smoking. Smoking is a known risk factor for osteoporosis, interfering with how the body uses vitamin D and calcium to strengthen bones, according to the University of Pittsburgh Schools of the Health Sciences. A 2001 meta-analysis published in Calcified Tissue International found that smoking increased the risk of lumbar, or lower, spine fractures by 13 percent in women and 32 percent in men.

Cutting back on or eliminating tobacco usage at any age can have positive effects on your future spinal health, Patel says.

Copyright 2017 U.S. News & World Report


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