A “dowager’s hump” does not always mean spinal fracture

Much of the fear generated around osteoporosis stems from pictures of stooped, hump-backed, downward-looking elderly women. This vertebral deformity, often called a “dowager’s hump” and technically known as “kyphosis,” has come to be a dreaded tell-tale sign of the crippling potential of osteoporosis. New research, however, indicates that contrary to popular opinion, this feared spinal deformity does not necessarily indicate that one has a vertebral fracture. Nor does having a dowager’s hump seem to predict the probability of a future spinal fracture.

Actually, this new Australian research is of great interest to me. In my office I have seen more than one very stooped, elderly woman whom I might well think was crippled by osteoporosis, yet her bone tests showed no such problem. While the dowager’s hump and severe kyphosis can be caused by multiple spinal fractures, it often is not. In fact, the relationship between kyphosis and spinal fracture was so weak that these Australian researchers concluded that the existence of even severe kyphosis is only of limited value in determining a person’s risk of having a vertebral deformity and is no value in determining that individual’s risk of future vertebral fracture. Spinal deformities and vertebral fractures can only be reliably diagnosed using x-ray technology or by means of vertebral fracture assessment, also known as vertebral morphometry deformity assessment. Thus, if I see someone very worried about spinal fractures, I suggest that they ask their physician for a spinal x-ray or a vertebral fracture assessment.

So, if having a dowager’s hump or kyphosis does not necessarily mean you have osteoporosis, what else might it mean? Well, the most common reason for such a hump is postural slouching associated with a loss of musculoskeletal integrity and strength. For many, standing tall and holding good posture is an exercise in itself. Other non-fracture reasons include certain diseases, developmental or congenital causes, and nutritional issues such as rickets from vitamin D deficiency.

Reference:

Prince, RL, et al. 2007. The clinical utility of measured kyphosis as a predictor of the presence of vertebral deformities. Osteoporosis International, 18:621-627.