Standing nice and tall
Most of us recall being reminded by our parents or teachers to practice good posture by telling us to “stand or sit up straight.” We probably paid little attention to this advice, although good posture is associated with self-confidence and good looks, if nothing else. Little did we realize that these early words of advice have longstanding implications more than we could have imagined.
Few young people are likely to equate their current posture with possible future problems such as the “dowager’s hump” referred to medically as hyperkyphosis. In the 1940s, the term “dowager’s hump” was coined to refer to an abnormal curvature of the spine that manifests itself as a hump in the upper back of older women. Until recently, most have attributed hyperkyphosis in the elderly to underlying spinal osteoporosis, but recent studies demonstrate that only one third of those with the worst degrees of kyphosis actually have underlying vertebral fractures.
Similar to other age-related diseases, there are probably multiple contributing causes of hyperkyphosis. In addition to vertebral fractures, its causes include a genetic predisposition, degenerative disc disease, weak musculature and habitual bad posture. Poor postural habits tend to exaggerate with time, to the point where they become irreversible.
Approximately 40 percent of people over the age of 70 suffer from hyperkyphosis, a condition that tends to only get worse with age. While most assume that the “dowager’s hump” only affects older women (hence the name), men too suffer from hyperkyphosis. However, the area of the spine that seems to be most affected does appear to differ by sex. While older women tend to develop the classic “dowager’s hump” that affects the upper spine, older men experience more cervical spine degenerative changes with aging. When severe, either can result in the person being unable to lift their head sufficiently upwards to be able to look forward straight and ahead when they walk.
Hyperkyphosis is cosmetically undesirable, but more importantly, it is associated with multiple adverse health problems. Older men and women with hyperkyphosis are more likely to have respiratory difficulty because the changes in spinal curvature can directly affect lung function.
Similarly, hyperkyphosis is associated with poor physical function where older affected persons are unable to bend over, climb stairs, or walk without difficulty. Due to postural changes possibly affecting balance, some say those with hyperkyphosis are more likely to fall and women with hyperkyphosis appear to be at increased risk for developing fractures. There have also been some studies linking hyperkyphosis to an increased risk of earlier death.
Unfortunately, current treatment for hyperkyphosis affecting older persons is limited. Since vertebral fractures are an important contributing cause of age-related hyperkyphosis, concerned individuals should consult their physician to make sure that they do not have osteoporosis, as it is often a silent disease.
Getting enough daily calcium and vitamin D are important factors related to good bone health. Most Americans obtain an average of about 400-500 mg of calcium daily from their diet, but should aim for about 1,200 mg daily. Current guidelines for vitamin D call for at least 800-1,000 IU daily for people over 50. However, even daily doses of 1,000-2,000 IU of vitamin D daily are considered safe. Apart from treatments for osteoporosis, there is no “pill” to help cure age-related hyperkyphosis and surgical intervention is reserved only for those with extreme cases where neurological function is compromised.
The best treatments for age-related hyperkyphosis include preventative care and physical therapy.
As a good portion of the population now sits at desk jobs hunched over a computer for hours, or sits in traffic commuting to and from work, the time is right to shift focus towards not only getting enough aerobic and weight bearing exercise, but also towards exercises that are aimed at developing core strength (e.g. abdominal and back extensor muscles). Education of correct posture, whether when sitting, standing, walking, or running will likely result in long-term beneficial health effects.
As the first baby-boomers are soon approaching age 65 in 2010, the percentage of the population who are considered “older” is rapidly expanding. Without intervention, we can only expect that the numbers of people suffering from hyperkyphosis and its associated ill-health consequences will increase. Postural awareness is the first step in helping to prevent age-related hyperkyphosis. Certainly, we should celebrate our expected increased longevity, but it would be best enjoyed if we all stand tall! In the end, our parents and teachers were right — one can never be too young to start practicing good posture.
Dr. Deborah M. Kado is an internist/geriatrician and associate professor with UCLA/Orthopaedic Hospital Department of Orthopaedic Surgery at the David Geffen School of Medicine at UCLA. She can be reached at (310) 319-1234.
