title: Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age.
abstract: OBJECTIVE
  Limited data exist on the natural history of thoracic kyphosis in elderly patients. The purpose of this study was to determine the statistical distribution of the thoracic kyphotic angle (TKA) measurement in older patients without vertebral body abnormalities when compared with a young population.
  
  
  METHODS
  The TKA was measured by Cobb angle on digital lateral chest radiographs in 90 patients >65 years of age, 60 patients 51-65 years of age, 67 patients 36-50 years of age, and 63 patients 18-35 years of age. Patients with vertebral compression, vertebral body angulation, congenital anomaly, or significant scoliosis were excluded.
  
  
  RESULTS
  In patients >65 years of age, average TKA was 41.9 degrees , but the distribution was unexpectedly bimodal, with a low mode at 28.3 degrees and an upper mode at 51.5 degrees (P < .001). Elderly women and men independently demonstrated a bimodal TKA distribution. Two-thirds of elderly women and half of elderly men had a TKA >40 degrees (upper mode). In young patients, average TKA was 26.8 degrees . In middle-aged patients, TKA was intermediate and nonbimodal.
  
  
  CONCLUSIONS
  The TKA distribution in elderly patients (>65 years) without vertebral body abnormality is unexpectedly bimodal (non-normal distribution) with a subpopulation of patients significantly more affected by extreme kyphosis. Extreme thoracic kyphosis therefore occurs independently in a large subset of people, in the absence of vertebral wedge compression. The development of extreme thoracic kyphosis might contribute to excess biomechanical stress in the spine and may identify a population at risk for future vertebral compression fracture in particular at the thoracolumbar junction.
authors.affiliation: Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA 15215, USA.
authors.forename: Walter S
authors.initials: WS
authors.lastname: Bartynski
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Heller
authors.forename: Stephen Z
authors.initials: SZ
authors.lastname: Grahovac
authors.forename: William E
authors.initials: WE
authors.lastname: Rothfus
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
mesh_terms: D000328:Adult; D000375:Aging; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*