Senior living: How to navigate age-related hyper-kyphosis

By Dr. Amandeep Bhalla, Guest columnist 

Hyper-kyphosis, a severe version of kyphosis — an excessive curvature of the thoracic spine commonly observed in senior adults — presents a significant challenge to many seniors.

As many of my patients age, the natural curvature of the spine may gradually increase, leading to the development of this condition. Often referred to as Dowager’s hump or gibbous deformity, hyper-kyphosis can impact quality of life for affected seniors. Patient’s may describe feeling “pitched forward.”

As we age, the spine can progressively angle forward about three degrees every decade, which over time can exaggerate the kyphosis. One of the primary factors in hyper-kyphosis is the weakening of spinal bones, which may result in compression fracture or cracks. This weakening is often associated with age-related changes in bone density and structure. Hyper-kyphosis is also recognized as a complex inherited trait, indicating that genetic factors may predispose individuals to develop this condition.

Hyper-kyphosis affects a significant proportion of older adults, with prevalence rates ranging from 20% to 40% among individuals aged 60 years and older. The consequences of hyper-kyphosis extend beyond the physical appearance of a rounded upper back. Seniors who struggle with hyper-kyphosis can have trouble performing day-to-day activities and a decrease in physical performance.

Additional causes of hyper-kyphosis include:

• Vertebral fractures: Age-associated hyper-kyphosis mainly results from vertebral fractures and about 36% to 38% of older adults with kyphosis have underlying vertebral fractures, typically occurring in the thoracic spine. These fractures may result from osteoporosis-related bone weakening or trauma.
• Low bone density: As one ages, their bone mineral density declines and increases the risk of fractures. Osteoporosis, characterized by deceased bone density and strength, is a common underlying factor contributing to vertebral fractures and subsequent hyper-kyphosis.
• Degenerative disc disease: Intervertebral discs, which provide cushioning between vertebrae, undergo degenerative changes with age. As discs lose hydration and elasticity, they shrink and lose height, contributing to a reduction in spinal curvature and an increased likelihood of hyper-kyphosis.
• Changes in posture: Age-related changes in posture, including decreases postural flexibility and muscle strength, can contribute to the development of hyper-kyphosis. Poor posture habits, sedentary lifestyles, and decreases in physical activity may exacerbate spinal curvature abnormalities over time.
• Intervertebral ligaments: With aging, the intervertebral ligaments that add stability to the spine tend to be more susceptible to loss of elastic tissue, calcification and ossification.

Seniors who struggle with hyper-kyphosis may experience decreased physical function, increased risk of falling, increased risk of fractures and impaired pulmonary function. Impaired pulmonary function may result from reduced lung capacity because of the abnormal curvature of the spine, leading to breathing difficulties and decreased oxygen intake. This can impact overall physical function and endurance, limiting activities of daily living and reducing quality of life.

The altered biomechanics associated with hyper-kyphosis can increase the risk of falls and fractures, further compromising mobility and independence. The chronic strain on the spine and surrounding muscles may contribute to persistent back and neck pain, while gastrointestinal issues such as difficulty swallowing or reflux may arise because of compression of the digestive organs by the exaggerated curvature of the thoracic spine.

Treatment of hyper-kyphosis

Treatment options for hyper-kyphosis vary depending on the severity of symptoms and underlying causes. Here are some common approaches:

• Physical therapy: For mild cases of hyper-kyphosis, physical therapy is often recommended. Exercise-based treatments focus on improving postural alignment, increasing flexibility and strengthening core muscles. Specific exercises may target spinal extensors and abdominal muscles to help support proper posture and reduce spinal curvature. Physical therapy can also address symptoms such as difficulty lifting the head, impaired balance and visual disturbances while walking.
• Bracing: Wearing a back brace can help provide temporary symptomatic relief by improving standing height and decreasing postural sway.
• Pharmacological treatment: Anti-resorptive and bone-building medication may be utilized due to the low bone density and spine fractures that are often associated with age-related hyper-kyphosis.
• Kyphoplasty: A procedure that reduces pain experienced by patients that have spinal fractures and works to correct deformities in the spine. This minimally invasive procedure involves the insertion of a balloon-like device into the fractured vertebrae to restore height and shape. Bone cement is then injected into the space to stabilize the fracture and relieve pain.

For seniors experiencing hyper-kyphosis symptoms, it is important to prioritize early recognition and proactive treatment to take steps to preserve their mobility, independence, and overall well-being.

Dr. Amandeep Bhalla is a board -certified, fellowship-trained orthopedic spine surgeon who specializes in treatment of the neck, back and spinal column with Memorial Orthopedic Surgical Group in Long Beach. He serves as the medical director of spinal surgery at MemorialCare Long Beach Medical Center.