The rehabilitation of hyperkyphotic posture in the elderly

The angle of thoracic kyphosis tends to increase with age resulting in hyperkyphosis in some individuals. While the term "kyphotic" is occasionally used to describe someone with accentuated thoracic curvature, hyperkyphosis is preferred since kyphosis itself refers to the normal sagittal angle of thoracic curvature. Epidemiolo-gic studies have demonstrated that age-related hyperkyphosis commonly affects the elderly population with estimates ranging from 20% to 40%. In addition, hyperkyphosis affects a substantial number of older men. Apart from being a cosmetic deformity, older persons who suffer from hyperkyphosis are at increased risk for a variety of adverse health outcomes that include poor physical function, pulmonary compromise, falls, fractures, and even earlier mortality. Most clinicians and patients have assumed that thoracic hyperkyphosis is a result of underlying spinal osteoporosis, but approximately two thirds of those who are most hyperkyphotic don't have vertebral fractures. Over the past few years, there has been increased awareness and focus on potential effective treatments for age-related hyperkyphosis. Of these treatments, exercise based interventions and spinal orthoses are conservative rehabilitation management techniques that have shown promise in potentially improving health outcomes for affected patients. To date, all of these types of trials have been small in scale, and most short in duration. In the future, larger rigorously designed clinical trials will be needed to test and confirm the efficacy and feasibility of the most promising treatments for age-related hyperkyphosis. This invited review will discuss hyperkyphosis in terms of its etiology, clinical associations, and treatment in elderly individuals.