The association between hyperkyphosis and fall incidence among community-dwelling older adults

Marije C. Koelé, Hanna C. Willems, Karin M.A. Swart, Suzanne C. van Dijk, Paul Lips, Lisette C.P.G.M. de Groot, Tischa J.M. van der Cammen, M. Carola Zillikens, Natasja M. van Schoor, Nathalie van der Velde*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Summary: Hyperkyphosis, an increased kyphosis angle of the thoracic spine, was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Hyperkyphosis could serve as an indicator of an increased fall risk as well as a treatable condition.  

Introduction: Hyperkyphosis is frequently found in adults aged 65 years and older and may be associated with falls. We aimed to investigate prospectively in community-dwelling older adults whether hyperkyphosis or change in the kyphosis angle is associated with fall incidence.  

Methods.: Community-dwelling older adults (n = 1220, mean age 72.9 ± 5.7 years) reported falls weekly over 2 years. We measured thoracic kyphosis through the Cobb angle between the fourth and 12th thoracic vertebra on DXA-based vertebral fracture assessments and defined hyperkyphosis as a Cobb angle ≥ 50°. The change in the Cobb angle during follow-up was dichotomized (< 5 or ≥ 5°). Through multifactorial regression analysis, we investigated the association between the kyphosis angle and falls.  

Results: Hyperkyphosis was present in 15% of the participants. During follow-up, 48% of the participants fell at least once. In the total study population, hyperkyphosis was not associated with the number of falls (adjusted IRR 1.12, 95% CI 0.91–1.39). We observed effect modification by age (p = 0.002). In the oldest quartile, aged 77 years and older, hyperkyphosis was prospectively associated with a higher number of falls (adjusted IRR 1.67, 95% CI 1.14–2.45). Change in the kyphosis angle was not associated with fall incidence.  

Conclusions: Hyperkyphosis was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Because hyperkyphosis is a partially reversible condition, we recommend investigating whether hyperkyphosis is one of the causes of falls and whether a decrease in the kyphosis angle may contribute to fall prevention.

Original languageEnglish
Pages (from-to)403-411
Number of pages9
JournalOsteoporosis International
Volume33
Issue number2
Early online date8 Sep 2021
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The original B-PROOF trial is supported and funded by The Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031), The Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; Orthica, Almere; NCHA (Netherlands Consortium Healthy Ageing), Leiden/Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15–004-003), The Hague; Wageningen University, Wageningen; VUmc, Amsterdam; Erasmus Medical Center, Rotterdam.

Publisher Copyright:
© 2021, The Author(s).

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