Age-related kyphosis

Disease Description (Causes and Symptoms)

• Definition summary: Senile kyphosis is a condition in which kyphosis (forward curvature of the back) of the thoracic and lumbar spine progresses mainly due to aging and osteoporosis, causing the back to protrude forward and affecting trunk posture and walking.
• Major causes and pathophysiology:
  • Vertebral compression fracture due to osteoporosis is the most common cause. As weakened vertebral bodies collapse, the forward tilt and kyphosis of the spine increase.
  • Weakness of the muscles around the spine (particularly the spinal extensors and back muscles), degenerative changes in the intervertebral discs, and joint changes promote progression.
  • Repeated microfractures and accumulated postural changes become fixed as chronic kyphosis.
• Major symptoms:
  • Hunched back (protruding back), decreased height (loss of height)
  • Low back pain and localized tenderness, pain during activities (such as walking, lifting objects, and climbing stairs)
  • Fatigue and reduced exercise tolerance, walking difficulty due to downward visual field limitation, impaired balance, and increased risk of falls
  • In severe cases, shortness of breath and digestive problems may occur due to restriction of the rib cage

Treatment Methods

• Diagnostic-based principles: Establish a treatment plan after evaluating fractures, nerve compression, and osteoporosis with imaging (plain X-rays), bone mineral density testing (DXA), and, if necessary, MRI and bone scans.
• Nonsurgical treatment (first-line):
  • Osteoporosis treatment: Calcium and vitamin D supplementation, antiresorptive agents (e.g., bisphosphonates), RANKL inhibitors (denosumab), and bone-forming agents (such as teriparatide)—select appropriate medication according to the patient's condition.
  • Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, short-term opioids if necessary, and muscle relaxants. Physical therapy and exercise therapy are recommended for chronic pain.
  • Use of a brace (spinal brace): For pain relief and postural support (short-term use is recommended).
  • Physical therapy and exercise: Spinal extension exercises, postural correction, and balance and muscle-strengthening programs (particularly for the core and back muscles).
  • Activity guidelines: Avoid prolonged bed rest (because of the risk of worsening osteoporosis). Gradually increase activity and prevent falls.
• Interventional treatment (selective):
  • Vertebroplasty: When pain from a compression fracture is severe and does not improve with conservative treatment, bone cement is injected to relieve pain and stabilize the spine.
  • Kyphoplasty: A balloon is used to partially restore the collapsed vertebra before cement injection, with the aim of correcting the deformity and relieving pain.
  • Orthopedic or neurosurgical fixation (such as spinal fusion): Considered in cases of severe deformity, instability, or neurological deficits, but requires careful decision-making because the risk of complications is higher in older adults and patients with osteoporosis.
• Precautions and risk of complications:
  • Discuss the advantages, disadvantages, and side effects of osteoporosis medications (bisphosphonates, denosumab, etc.) in advance, including gastrointestinal problems, osteonecrosis, and hypocalcemia.
  • Vertebroplasty and spinal fusion carry risks of complications such as bleeding, infection, and fractures of adjacent spinal segments.
  • Long-term brace use can cause muscle weakness, so it should be combined with physical therapy and limited in duration.
• Prognosis:
  • Pain and function may improve with early fracture treatment and osteoporosis management, but complete recovery from already advanced kyphosis (deformity) is difficult. Preventing refracture and strengthening the muscles are important.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Recommended items to bring:
  • A list of current medications and supplements (including calcium and vitamin D), and a history of allergies
  • Previous test results (copies of recent X-rays, DXA bone mineral density tests, and MRI results, if available)
  • History of fractures and falls (when and how the injury occurred)
  • A record of symptom changes (when they began, the severity and pattern of pain, and the degree of activity limitation), and a pain score (0–10)
  • Information about the living environment (whether the person lives alone, whether walking aids are used, and fall hazards in the home)
• Things to check yourself before the outpatient visit:
  • Recent changes in weight and height, and whether there have been changes in urination or bowel movements, shortness of breath, or difficulty swallowing
  • Whether there is acute severe pain suggestive of a fracture or weakness in the limbs (neurological symptoms)
• Showing the doctor symptom photos (such as posture viewed from the side) or a walking video during the outpatient visit may be helpful.

Examples of General Questions to Ask the Doctor

• "Is it recommended that I start osteoporosis medication in my situation? What are the advantages and disadvantages of the available medications?"
• "What medication or procedure do you recommend for pain management? What side effects can occur?"
• "How much exercise or physical therapy should I start with, and what type of program would be appropriate?"
• "Is there a risk that my spinal deformity will progress further? What is the prognosis?"
• "Are there any movements I must avoid or precautions I should take in daily life (such as housework and walking)?"

Examples of Disease-Specific Questions

• "Do I meet the indications for vertebroplasty/kyphoplasty? What are the expected benefits and risks?"
• "Among osteoporosis medications (e.g., bisphosphonates or denosumab), which treatment is more appropriate for my age and physical condition, and what will the treatment duration and monitoring plan be?"