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After spending some time with my 80-year-old mom recently, I went to give her a hug and a kiss goodbye when I was struck by how much smaller she’s become. Sure, I’ve been noticing her shrinking stature for at least a few years now, but every so often I still get surprised by how much shorter and less muscular she is throughout her upper body. Also becoming more obvious is the humped back or hunchback she’s developing, just like her mom did in her 80s.
By the time my grandmother died after breaking her hip at age 90, she had classic osteoporosis symptoms, including a severe forward bend in her spine—the “dowager’s hump,” as it’s called. Living for years with osteoporosis left her bones thin, weak, and fragile. This caused silent, tiny fractures in her thoracic vertebrae, the bones in the mid-section her spine. The severe rounding of her upper back was likely a sign of advanced osteoporosis, the result of compression fractures of weakened vertebrae.
What Causes “Hunchback”?
Before the common use of dual-energy x-ray absorptiometry (DEXA) to measure bone mineral density in the early 21st century, the osteoporosis symptoms of fractured vertebrae, height loss, and forward bending of the spine, commonly known as hunchback, were the most frequent presenting complaints. The medical term for hunchback disease is kyphosis; severe kyphosis is known as dowager’s hump.
Kyphosis and height loss are common osteoporosis symptoms. Decreased bone mineral density in the thoracic vertebrae causes compression fractures. Osteoporotic compression fractures usually occur during routine daily activities such as bending of the body, coughing, lifting or some other kind of trivial trauma. Multiple compression fractures, as seen with osteoporosis, cause changes within the structure of the spine that lead to significant height loss and development of kyphosis (dowager’s hump).
Osteoporosis Symptoms from Spinal Fractures
Like most people with osteoporosis, my grandmother likely experienced no symptoms as her bones slowly weakened over the years. Even as her vertebrae fractured, compressed, and deformed, leading to her stooped over position, she may not have felt pain. Neither has my mother, luckily. Up to two thirds of people have no symptoms after these types of vertebral fractures.
Others may suffer from quick onset of pain, which might disappear or turn into chronic, dull, aching, or intermittent back pain and stiffness. Sometimes, compression fractures of the spine cause significant back pain that may be sharp, knifelike, and disabling and which often subsides over a period of weeks to months.
As the thoracic part of the spine curves more severely, it displaces the head and neck forward, causing a compensatory increase in curve in the lower back and pushing the lower abdomen out. Even if it causes no pain, the increased curve of the low back can cause other osteoporosis symptoms such as a protuberance of the abdomen, a change in the way clothes fit, and loss of the waist. Meanwhile, the forward shifting of the head and neck can restrict the ability to look upward and therefore can affect driving and cause difficulty with lying face down.
More severe kyphosis can also cause additional osteoporosis symptoms such as loss of shoulder range of motion. This can interfere with overhead activities of daily living. With severe deformity, balance may also become impaired. Not only is the risk for falls greater, more energy is required for standing and moving around because the spinal balance becomes disrupted and the center of gravity is displaced.
Other osteoporosis symptoms resulting from more severe cases of kyphosis include shortness of breath, fatigue, and poor activity tolerance caused by the rib cage losing its ability to expand with breathing,
How to Prevent Hunchback in Old Age
It may have been too late to save my grandmother from developing her severe dowager’s hump, but my mom still has decent bone mass and great mobility for a woman her age (and a breast cancer survivor, no less).
Studies show hunchback treatment includes staying active, strengthening back muscles along the spine, and slowing bone density loss. Working on her posture and keeping her degenerative arthritis from progressing may also help.
Kyphosis and Osteoporosis/Osteoarthritis
There is new evidence that both poor posture and degenerative disc disease caused by osteoarthritis may also contribute to kyphosis in older people. Researchers recently began noticing that vertebral fractures don’t seem to be responsible for all cases of kyphosis. Simply having weak back muscles, poor posture, or poor health of the vertebral discs associated with degenerative joint disease can increase kyphosis.
Even in cases in which vertebral fractures are osteoporosis symptoms, there is evidence that working on posture and building strength in the back muscles helps improve the kyphosis and keeps it from getting worse.
Women with kyphosis like my mom are not doomed to develop my grandmother’s dowager’s hump. And even though there is clearly a genetic component to kyphosis, neither am I. In addition to trying to eat right, taking our nutritional supplements and using other natural therapies for bone health, we’ll both be working on our posture and strengthening our back muscles with resistance training exercise. Both have been shown to be helpful for reversing kyphosis and other osteoporosis symptoms.
Of course, these are excellent methods for improving many aspects of health, not just for keeping the spine healthy and aligned. Even young, athletic women need to take care to prevent osteoporosis.
See also these University Health News posts:
- What Is Osteopenia
- Osteoporosis -2.5: Understanding What Leads to That Bone Mineral Density Score
- Osteoporosis -3.0: What Your T-Score Means for Your Bone Health
This blog originally appeared in 2012 and has been updated by the editors of University Health News.