Osteoporosis and spinal deformity
Published on 18 October 2008
Large numbers of elderly people develop a hunched back. They can suffer persistent pain, find it difficult to get around, report feelings of low self esteem and fear losing their independence. Researchers have discovered that vertebrae can become deformed without being injured or fractured, and believe poor posture may be to blame. Their studies could help identify who’s at risk of developing a hunched back and lead to new ways to prevent this disabling deformity.
What's the problem and who does it affect?
Chronic pain and increasing deformity
As our population ages, increasing numbers of elderly people are developing a hunched back – the so-called ‘Dowager’s hump’. Many suffer back pain that is persistent and severe, often requiring prolonged use of painkillers.
Sadly, many people find their back gradually becomes more and more hunched. Increasing levels of deformity can have marked effects on a person’s self-esteem, with many sufferers saying they feel they have lost their dignity.
As the condition worsens, getting around can become so difficult that many people face losing their independence altogether. People with a badly hunched back can have problems breathing and even lying down can be difficult, making it hard to get enough sleep.
People with osteoporosis – whose bones are fragile and prone to fracture – are known to be at high risk of developing a hunched back. It’s long been thought that fractures to individual vertebrae in the back cause their deformity. But many sufferers cannot remember an accident that might have caused their bone to break. Researchers now suspect that poor posture may play a role as well, but more evidence is needed.
What is the project trying to achieve?
Can poor posture cause a ‘creep’ towards deformity?
People with hunched backs are known to have changes in the individual bones – or vertebrae – that make up their back bone. It’s long been assumed that these changes result from fractures. This is probably true in some causes. Indeed, statistics suggest people with osteoporosis suffer 120,000 vertebral fractures each year in the UK.1
However, the researchers working on this project think that fractures might not be the only cause of hunched backs. They have preliminary evidence to suggest that sitting or standing in a stooped position might slowly cause vertebrae to become deformed over time. This gradual deformation is called ‘creep’.
In this project, the researchers are investigating the role of creep using sections of human spines. They hope to answer a variety of key questions: Does vertebral creep produce a large enough deformity to explain the hunched backs of elderly people? Does creep occur in all vertebrae, or just in those with osteoporosis or a previous injury? Is it affected by age or gender? Can it be reversed?
What are the researchers' credentials?
|Project Leader||Dr M A Adams, BSc, PhD|
|Location||Department of Anatomy, University of Bristol|
|Grant awarded||18 July 2008|
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The project leader, Dr Mike Adams, and his wife, Dr Trish Dolan, who is also working on this project, are world experts in spinal mechanics and have published more than 100 papers on the subject. They were invited to contribute to the latest (40th) edition of Gray’s anatomy, an honour that goes to renowned experts.
Dr Adams and Dr Dolan lead one of the few teams in the UK that can perform mechanical experiments on samples of human spines in their natural state – that is without using preservatives that alter their mechanical properties. This negates the need to use animals in the research and increases the clinical applicability of the results.
The team uses specially designed equipment that can simulate the stresses and strains of everyday movements and monitor the response of vertebrae. They have developed a system for measuring very small deformations of human bones – as little as 1/100 of a millimetre.
Who stands to benefit from this research and how?
Towards new treatments
The researchers aim to find out whether it is possible that poor posture – sitting or standing in a stooped position for prolonged periods of time – can slowly cause elderly people to develop a hunched back through the gradual process known as ‘creep’. They also hope to reveal who is most at risk of this type of spinal deformity.
The researchers hope their work will eventually lead to new ways to stop elderly people from developing a hunched back, or to slow down the gradual progression towards this deformity. Possible interventions could involve specific exercises, advice on posture and orthotic devices, such as corsets that help people maintain a good posture and reduce the time spent stooped. The effectiveness of any new interventions could be tested in future clinical trials.
Finding new ways to stop or slow the gradual progression towards a hunched back would have far reaching benefits to the increasing number of elderly people in our ageing population. It would free them from pain and disability, increase their self esteem and quality of life, and help them maintain their independence for longer.
- Felsenberg D et al. [EPOS Study Group] (2002). Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 17:716-24.