title: Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study.
abstract: BACKGROUND
  Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis and/or flexed posture with future fall incidents in older adults within the next year.
  
  
  METHODS
  Patients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months.
  
  
  RESULTS
  Fifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls.
  
  
  CONCLUSIONS
  Older adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture.
authors.affiliation: Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. hannavanderjagt@hotmail.com.|Department of Internal Medicine and Geriatrics, Academic Medical Center, Amsterdam, The Netherlands. hannavanderjagt@hotmail.com.
authors.forename: Hanna C
authors.initials: HC
authors.lastname: van der Jagt-Willems
authors.affiliation: Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. mhdegroot@gmail.com.|School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands. mhdegroot@gmail.com.
authors.forename: Maartje H
authors.initials: MH
authors.lastname: de Groot
authors.affiliation: Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. jos.vancampen@slz.nl.
authors.forename: Jos P C M
authors.initials: JP
authors.lastname: van Campen
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands. c.j.c.lamoth@umcg.nl.
authors.forename: Claudine J C
authors.initials: CJ
authors.lastname: Lamoth
authors.affiliation: Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands. wf.lems@vumc.nl.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D011187:Posture; D011446:Prospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000293:injuries*