Member Research and Reports

Member Research and Reports

Measures of Kyphosis Linked to Incident Falls in San Diego Research Study

Hyperkyphosis, an extreme forward curvature of the upper spine, is commonly seen among older adults. It can be caused by several conditions including vertebral fractures and degenerative disc disease. The condition commonly progresses with age and has been linked to increased risk of fractures, diminished physical function, and mortality.

A prospective cohort study led by Dr. Deborah Kado of the UCSD School of Medicine with the assistance of Dr. Corinne McDaniels-Davidson, director of the SDSU Institute for Public Health examined whether older adults with hyperkyphosis were at an increased risk for falls and injurious falls over a one-year period.

Researchers collected data on 72 women and men, aged 65 and older, from the San Diego, CA community. The study examined the association between four common measures of kyphosis and both incident and injurious experienced by the participants over one year of follow-up. Two standing measures and two lying measures were used. The first standing measure entailed measurements with a flexicurve ruler pressed against the back to calculate the kyphotic index. The Debrunner kyphometer, a device with movable arms extending from a protractor to measure the kyphotic angle, was the second standing measure used. The lying measures consisted of the blocks method, a count of the number of 1.7 cm blocks required to reach a neutral head position while lying flat, and the Cobb angle, the angle of kyphosis measured from Dual-energy X-ray absorptiometry (DXA)-based vertebral fracture assessment images.

After kyphosis was measured, participants were followed for one year with monthly check-ins to determine whether they experienced any falls and/or fall injuries. In the course of the year 64 percent of participants experienced at least one falling incident and 35 percent experienced an injurious fall. The researchers found that all of the four measures of kyphosis were significantly associated with incident falls. The adjusted odds of an incident fall more than doubled for each standard deviation increase in the measures of kyphosis. The findings were less consistent with injurious falls, however, with only the blocks measure demonstrating an association.

Results indicated that participants with greater kyphosis were more likely to suffer a fall. Moreover, the consistent results across each of the four measures provides evidence that simple methods, such as the blocks measure, are as robust as more invasive kyphosis measurement methods at predicting fall risk, and perhaps other functional declines. With the blocks method having the strongest association with injurious falls, the study hints at the potential for future clinical utility in fall risk assessments.

The study was published online 10 October in the journal Osteoporosis International.