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Am Fam Physician. 1998;57(8):1961-1965

The lifetime risk of vertebral fracture is estimated to be nearly twice as high as the risk of hip fracture in women older than 50 years. A common sequela of vertebral fracture is the development of kyphosis, causing deformed posture and potentially impaired pulmonary function. Ryan and Fried assessed the impact of kyphosis on physical function and mobility.

The study included 231 women aged 59 to 89 years who were living in the community. Women were excluded from participation if they could not stand unaided for 30 seconds or if their Folstein Mini-Mental Status Examination score was less than 18. Kyphosis was classified as mild (slight rounding of the upper back and shoulders), moderate (a definite “widow's hump”) or severe (inability to raise the head level). Mobility was assessed by means of various performance-based tests, such as the time required to walk 5 meters (5.5 yards) and the time required to walk up and down a flight of stairs.

A majority of the women (57 percent) reported a diagnosis of arthritis, but only 11 percent reported a diagnosis of osteoporosis. Fewer than 1 percent reported a history of vertebral fracture. Twenty-seven percent of the women had no kyphosis. Kyphosis was mild in 42 percent, moderate in 26 percent and severe in 5 percent of the women. Quantitative measures of the kyphosis ranged from zero to 15 cm. An increased degree of kyphosis was associated with longer walking and stair-climbing times. Kyphosis also affected the ability to reach for objects and perform heavy housework.

The authors conclude that osteoporosis, with consequent kyphosis, may have even more of an impact on a patient's functional level than was previously thought. Only 11 percent of the women in this study knew that they had osteoporosis, yet 31 percent had moderate or severe kyphosis. The impact of kyphosis may be a consideration in counseling patients on the prevention and treatment of osteoporosis.

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Copyright © 1998 by the American Academy of Family Physicians.

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