Keeping Kyphosis in Check

When viewed from the side (laterally), the human spine has three natural “C” curves. It curves inward at the neck, outward at the upper back, and then inward again at the lower back. But when the curve at the upper back—of the thoracic vertebrae—is excessive, it is called kyphosis (or hyperkyphosis, but we will simply refer to it as kyphosis here).

There are no standard criteria for evaluating kyphosis, but it is commonly considered to be a curve greater than 40 or 45 degrees. It’s thought that some 20 to 40 percent of people over age 60 have kyphosis to some degree, with women making up the lion’s share of those affected and with progression occurring over time (as much as 8 to 9 degrees per decade).

Mild kyphosis may not cause any symptoms or even be noticeable. But with progression—as vertebrae in the upper back become more wedge-shaped—it can cause the back to look rounded, hence the nicknames “roundback,” “hunchback,” and “dowager’s hump.” Depending on the degree of kyphosis, as well as the extent of associated tightness of the back muscles, the symptoms can include persistent upper back pain, stiffness, and both muscular and general fatigue.

In more severe cases, kyphosis can cause difficulty breathing and weakness in the arms and legs; ultimately, it can affect walking and balance (which increases the risk of falling) and limit other physical functioning, making it harder to lift one’s head, get out of a chair, and perform daily life activities such as dressing and bathing.

What’s behind kyphosis?

Age-related kyphosis is especially seen in postmenopausal women who have osteoporosis and is attributed to vertebral (spinal) fractures. (In turn, kyphosis from spinal fractures begets an increased risk of more spinal fractures in the thoracic spine because it causes a greater load on the vertebrae as the spine bends farther forward.)

It’s not otherwise clear what causes age-related kyphosis, but the condition may also be related to degenerative disc disease (with no fractures), and there may be a genetic predisposition. Other factors that may increase risk, according to some research, include being overweight (perhaps because of poor muscle tone and poor posture), having low bone mineral density, and smoking. And some (but not all) studies have linked weak spinal muscles to kyphosis, though it’s not known if the weakness is a cause or effect of the curvature.

Among the factors that may increase its progression is weight loss, one study reported, possibly because weight loss often results in muscle loss.

Can you develop kyphosis by hunching over all day at your desk, staring down at your phone for hours on end, or just having bad posture? So-called postural kyphosis is most apparent in teens who slouch. But, unlike with age-related and other structural causes of kyphosis, this isn’t linked to any significant abnormalities in the vertebrae, can usually be corrected by being attentive to good posture and strengthening back muscles, is rarely painful, and doesn’t typically progress to spinal problems in adulthood. On the other hand, the ability to self-correct a stooped posture and be more erect—something called postural flexibility—decreases with age, perhaps due to stiffening of connective tissue of the spine.

Check and treat it

If you have any signs or symptoms of kyphosis, consider getting evaluated by your physician, who may order an X-ray or other imaging test to assess the degree of curvature and to rule out other conditions, notably a spinal fracture, which could also cause pain. If you haven’t been assessed for osteoporosis before, a bone density test might be done, depending on your age and other risk factors for this condition. You may also be referred to a specialist such as an orthopedist or physiatrist.

Engaging in a regular exercise routine that includes back extension, flexibility, core, and postural exercises may help (see box below). A physical therapist can provide exercises that target an individual’s specific needs and instruct on proper alignment. Some physical therapists also apply a special tape (kinesiology) or use a taping technique (McConnell) across specific areas of the upper back to improve posture. In addition, your doctor may prescribe a custom-fitted flexible brace (referred to as a spinal orthosis), which may help improve kyphosis by providing proprioception (awareness of where your body is in space) that helps you unconsciously change your posture and use the associated back muscles. But the long-term effectiveness of taping and bracing is not clear.

There’s limited evidence showing benefits of medication, but a large study in the Journal of Bone and Mineral Research in 2010 found that taking strontium renelate (a drug used to treat osteoporosis in Europe and Australia but not approved by the FDA in the U.S.) slowed progression of kyphosis, compared to a placebo. More research is needed to confirm this benefit as well as the drug’s safety, particularly in people at elevated risk of cardiovascular events. Osteoporosis medications may help prevent spinal fractures that could increase kyphosis. Surgical procedures should only be considered as a last resort—for example, if there is persistent or increasing pain and disability or significant difficulty with lung function.

BOTTOM LINE: Though there’s still so much we don’t know about kyphosis, there are several steps you can take to perhaps reduce your risk or slow its progression. That includes maintaining good posture, being physically active, staying at a healthy body weight, and, if indicated, getting screened for osteoporosis. If you’re at risk for or have osteoporosis, it’s especially important to do weight-bearing exercises, not smoke, and eat a healthy, varied diet that supplies bone-essential nutrients (take a calcium supplement if your diet doesn’t provide enough and a vitamin D supplement if you’re deficient based on a blood test).