Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study.
It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. In 596 community-dwelling women, we found that with increasing kyphosis, there was a significant trend of increasing fracture risk that was independent of previous history of fractures or BMD.


BACKGROUND
It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures.


METHODS
We conducted a prospective cohort study of 596 community-dwelling women, 47-92 years of age. Between 1988 and 1991, BMD of the hip and spine and kyphosis were measured. Kyphosis was measured by counting the number of 1.7-cm blocks necessary to place under the occiput so participants could lie flat without neck hyperextension. New fractures were reported over an average follow-up of 4 years.


RESULTS
Using a cut-off of at least one block, 18% of the participants had hyperkyphotic posture (range, one to nine blocks). There were 107 women who reported at least one new fracture (hip, spine, wrist, clavicle, shoulder, arm, hand, rib, pelvis, leg, or ankle). In logistic regression analyses, older women with hyperkyphotic posture (defined as at least one block) had a 1.7-fold increased risk of having a future fracture independent of age, prior fracture, and spine or hip BMD (95% CI: 1.00-2.97; p = 0.049). There was a significant trend of increasing fracture risk with increasing number of blocks, with ORs ranging from 1.5 to 2.6 as the number of blocks increased from one to at least three blocks compared with those with zero blocks (trend p = 0.03; models adjusted for age, baseline fracture, spine or hip BMD). Stratification by baseline fracture status and controlling for other possible confounders or past year falls did not change the results.


CONCLUSIONS
Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history.
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA.
Mei-Hua
MH
Huang
Elizabeth
E
Barrett-Connor
Gail A
GA
Greendale
Deborah M
DM
Kado
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D015331:Cohort Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology*; D006615:Hip / Q000000981:diagnostic imaging; D025981:Hip Injuries / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D007738:Kyphosis / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D011187:Posture; D011859:Radiography; D012306:Risk; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries