Does Kyphosis Get Worse With Age? Understanding the Factors and Managing Progression

According to a UK Biobank study, spinal curvature increases with age, with the kyphotic angle in males and females increasing by about 2.42° per decade. This statistic reveals that for many, the answer to "does kyphosis get worse with age?" is yes, and this progression is a common characteristic of aging that is influenced by physiological changes within the musculoskeletal system.

Quick Summary

Age-related progression of kyphosis is common due to factors like muscle weakness, osteoporosis, and degenerative discs. Certain types, like Scheuermann's and congenital kyphosis, are inherently progressive. Management and treatment options, including physical therapy and exercises, can help slow its worsening and mitigate its impact.

Key Points

• Age-Related Progression Is Common: For many, kyphosis does get worse with age, with the kyphotic angle increasing steadily due to natural degenerative processes.

• Osteoporosis Is a Key Driver: In older adults, weakened bones from osteoporosis can lead to vertebral compression fractures, causing vertebrae to become wedge-shaped and increasing spinal curvature.

• Degenerative Discs Contribute to Curvature: The flattening and shrinking of intervertebral discs over time is another major factor in the progression of kyphosis.

• Muscle Weakness Worsens Posture: The atrophy of back extensor muscles with age makes it harder to maintain an upright posture and control spinal alignment, exacerbating the curve.

• Exercises Can Slow Progression: Targeted exercises and physical therapy can strengthen supporting muscles and improve posture, helping to slow the worsening of kyphosis and improve function.

• Progression Varies by Kyphosis Type: While age-related kyphosis typically progresses gradually, other types like Scheuermann's and congenital kyphosis have different, often more predictable, progression patterns.

• Worsening Kyphosis Impacts Health: The consequences of a progressing curve include increased pain, impaired balance, higher risk of falls, and reduced lung function in severe cases.

What Drives Age-Related Kyphosis Progression?

For many people, the natural aging process brings about changes to the spine that contribute to a worsening kyphosis. While a small degree of thoracic curvature is normal, a measurement over 40° is defined as hyperkyphosis, and the risk of developing this increases with age. The progression is often multi-factorial, stemming from a complex interplay of structural and muscular changes.

• Decreased Bone Mineral Density: Osteoporosis is a primary driver, especially in older women. Weak and brittle vertebrae are more susceptible to compression fractures, which cause the vertebral bodies to become wedge-shaped and lead to increased spinal curvature.
• Degenerative Disc Disease: The soft, circular discs that cushion the vertebrae flatten and shrink with age. This loss of disc height contributes to the forward rounding of the spine. Some research suggests degenerative disc changes may have an even stronger association with kyphosis than vertebral fractures.
• Weakened Spinal Muscles: Age-related muscle loss, or sarcopenia, affects the extensor muscles in the back that support the spine. Weakened back extensors make it more difficult to maintain an upright posture and control the curvature, especially as the center of gravity shifts forward. Studies show a strong inverse relationship between back extensor strength and the severity of kyphosis.
• Changes in Postural Control: With age, a decline in proprioception (the body's sense of position), along with changes in the visual and vestibular systems, can negatively impact postural stability. This makes it harder for the body to sense and correct for a stooped posture.

Comparing Types of Progressive Kyphosis

While age-related (senile) kyphosis is most common, other types of kyphosis can also progress, though with different timelines and underlying causes. A comparison helps illustrate these distinctions.

Feature	Age-Related (Senile) Kyphosis	Scheuermann's Kyphosis	Congenital Kyphosis
Onset	Usually develops gradually in middle to older age, with a noticeable increase after age 40.	Becomes apparent during the adolescent growth spurt, typically between ages 10 and 15.	Present at birth due to improper spinal development in the womb.
Cause	Primarily caused by age-related factors like degenerative disc disease, osteoporosis, and muscle weakness.	A developmental disorder where vertebrae grow wedge-shaped instead of rectangular. Often has a genetic component.	Vertebrae form abnormally or fuse together in the womb.
Progression	Tends to worsen gradually over time due to continued degenerative changes. The mean angle may increase by 3° per decade after age 50.	Typically progresses during the growth spurt and often stops worsening once skeletal maturity is reached. However, back pain may persist into adulthood.	Often progressive and requires early treatment, as the curve can worsen as the child grows.
Primary Treatment	Focuses on managing pain, slowing progression with exercises, strengthening back muscles, and treating underlying osteoporosis.	Involves bracing during adolescence to stop curve progression. Surgery may be needed for severe cases.	Surgery is often necessary at a young age to prevent severe, progressive curvature.
Rigidity	Can be rigid if structural changes have occurred, but postural components may be somewhat flexible.	Characterized by a rigid, non-correctable curvature.	The curvature is rigid due to congenital vertebral deformities.

What are the Consequences of Progressive Kyphosis?

The health implications of worsening kyphosis extend beyond just cosmetic concerns or a visible hump. The increased curvature can significantly impact a person's physical function and quality of life.

• Pain and Discomfort: The continuous strain on muscles, ligaments, and joints often leads to chronic back, neck, and shoulder pain. Compensatory changes in posture to maintain balance can also cause pain in the lower back and hips.
• Impaired Mobility and Balance: The forward shift in the body's center of gravity can increase postural sway and impair balance, leading to a higher risk of falls. This can lead to a reduction in physical activity and mobility.
• Reduced Pulmonary Function: In severe cases, the rounded posture can compress the lungs and diaphragm, restricting breathing and decreasing lung capacity. Studies show that people with hyperkyphosis often experience decreased forced expiratory volume and vital capacity.
• Difficulty with Daily Activities: Functional limitations are common. Individuals may have difficulty with daily tasks like reaching, bending, and performing housework, which can significantly affect their independence and overall quality of life.

Can You Prevent or Slow the Progression?

While not all causes of kyphosis can be prevented, proactive measures can help manage symptoms and slow the progression, particularly for age-related kyphosis. Treatment is typically conservative and non-invasive, focusing on improving posture and strengthening supporting muscles.

• Exercise and Physical Therapy: This is a cornerstone of management. A physical therapist can prescribe targeted exercises to strengthen back extensor and core muscles, stretch tight hamstrings and chest muscles, and improve spinal flexibility. Regular activity and postural alignment training are key.
• Maintain Bone Health: Since osteoporosis is a major contributing factor, steps to maintain bone density are crucial. This includes a diet rich in calcium and vitamin D, regular weight-bearing and resistance exercises, and, if needed, medication to manage osteoporosis.
• Posture Training: Practicing correct posture while sitting, standing, and performing daily activities can help retrain the body and prevent further slouching. Using ergonomic setups at workstations is also beneficial.
• Pain Management: For pain caused by kyphosis, over-the-counter pain relievers or prescription medication may be used. Pain reduction allows for more comfortable participation in strengthening exercises.
• Addressing Underlying Issues: If kyphosis is caused by an underlying condition like osteoporosis or a compression fracture, treating that condition is essential to prevent worsening curvature. In some cases of acute, painful fractures, a procedure like kyphoplasty may be used to restore vertebral height.

Conclusion

Kyphosis can and often does get worse with age, driven by natural degenerative changes to the spine, such as weakening bones from osteoporosis, deteriorating intervertebral discs, and muscle atrophy. However, the trajectory is not inevitable, and the progression can be managed effectively, especially with early and consistent intervention. By focusing on spinal strengthening exercises, maintaining proper posture, treating underlying bone health issues, and addressing pain, individuals can slow the worsening of their spinal curve. This proactive approach can significantly mitigate associated symptoms like pain, mobility issues, and balance problems, leading to a better quality of life as they age. Consulting a healthcare provider for a proper diagnosis and a personalized management plan is the first and most crucial step toward controlling the condition and its progression.

Check out more information on age-related spinal changes from MUSC Health.

Frequently Asked Questions

What causes kyphosis to progress with age?

The progression of kyphosis with age is typically caused by a combination of factors, including weakened bones from osteoporosis leading to compression fractures, degenerative changes in the spinal discs that cause them to flatten, and the weakening of back extensor muscles.

Can exercise help prevent kyphosis from getting worse?

Yes, exercise and physical therapy are effective tools for managing and slowing the progression of kyphosis. Strengthening back and core muscles, improving spinal flexibility, and practicing proper posture can all help counteract the age-related changes that contribute to worsening curvature.

Is age-related kyphosis the same as Scheuermann's kyphosis?

No, they are different. Age-related (senile) kyphosis is a degenerative condition that occurs later in life, while Scheuermann's kyphosis is a developmental disorder that typically appears during adolescence. Scheuermann's is a rigid curvature caused by wedged vertebrae, while age-related kyphosis is often more flexible initially.

Does kyphosis increase my risk of falling?

Yes, progressive kyphosis can increase your risk of falling. The excessive forward curvature shifts your body's center of gravity forward, which can impair balance and lead to an increased risk of falls, particularly in older adults.

Are older women more at risk for worsening kyphosis?

Yes, older women, particularly those with osteoporosis, are more susceptible to worsening kyphosis. Estrogen loss after menopause contributes to decreased bone mineral density, increasing the risk of vertebral fractures that cause the spine to curve.

What are the long-term health consequences of progressive kyphosis?

Beyond cosmetic concerns, progressive kyphosis can lead to chronic back pain, impaired mobility, reduced lung function due to chest compression, and difficulty performing daily activities. It can also increase the risk of fractures and has been associated with higher mortality.

When should I see a doctor for worsening kyphosis?

You should see a doctor if you notice a significant or rapid increase in your spinal curve, or if you experience increasing pain, loss of balance, or neurological symptoms like numbness or weakness. An early diagnosis is crucial for effective management and slowing progression.