Skip to main content

The Prevalence and Negative Effects of Thoracic Hyperkyphosis on Chinese Community-Dwelling Older Adults in Wuhan, Hubei Province, China

Abstract

Background

Globally, 20% to 50% older adults have been found to have thoracic hyperkyphosis. Negative effects on physical performance have been reported. However, there has been a lack of research on the prevalence and negative effects of thoracic hyperkyphosis among Chinese community-dwelling elderly.

Design

A cross-sectional study.

Setting

The communities in Wuhan, China.

Participants

Three hundred and ninety-five Chinese community-dwelling older adults with thoracic hyperkyphosis.

Measures

Chinese community-dwelling older adults aged 60 or above lived in Wuhan, China from August to December 2018 were recruited for spine and physical performance assessments. The primary outcome was the prevalence of thoracic hyperkyphosis estimated according to the angle of kyphosis which was measured by manual inclinometers. The secondary outcomes were the effects of thoracic hyperkyphosis on physical performance measured by One-leg Standing Test (OLS), Timed Up & Go Test (TUG), Chest Expansion Test (CE), Six Minutes Walking Test (6MWT), and Farsi Version of Functional Gait Assessment (FGA). The socio-demographic and health-related information were collected by a questionnaire.

Results

Among 395 participants, the mean angle of kyphosis was 49.0° ± 10.5°, 75.2% of participants had the angle of kyphosis >40° (i.e., having thoracic kyperkyphosis). Compared with older adults having no thoracic hyperkyphosis, older adults with thoracic hyperkyphosis had increased risks performing impaired in OLS (OR=4.55, 95% CI 2.18–9.53, p<0.001), TUG (OR=6.08, 95% CI 2.57–14.40, p<0.001), CE (OR=3.23, 95% CI 1.63–6.38, p=0.001), 6MWT (OR=4.64, 95% CI 1.98–10.86, p<0.001), and FGA (OR=5.18, 95% CI 2.25–11.89, p<0.001) after controlling socio-demographic and health-related factors.

Conclusion

The thoracic hyperkyphosis had high prevalence and associated with impaired performance in balance, gait, and cardiopulmonary function tests among Chinese community-dwelling older adults, which calls for the future intervention.

This is a preview of subscription content, access via your institution.

References

  1. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352–60.

    PubMed  PubMed Central  Google Scholar 

  2. Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res. 2017;29(4):567–77.

    PubMed  Google Scholar 

  3. Katzman WB, Vittinghoff E, Kado DM. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteoporos Int. 2011;22(1):85–90.

    CAS  PubMed  Google Scholar 

  4. Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. J Am Geriatr Soc. 2004;52(10):1662–7.

    PubMed  Google Scholar 

  5. Katzman WB, Vittinghoff E, Kado DM, Schafer AL, Wong SS, Gladin A, et al. Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol of a randomized controlled trial of multimodal spine-strengthening exercise in older adults with hyperkyphosis. Phys Ther. 2016;96(3):371–81.

    PubMed  Google Scholar 

  6. Takahashi T, Ishida K, Hirose D, Nagano Y, Okumiya K, Nishinaga M, et al. Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people. Osteoporos In. 2005;16(3):273–9.

    Google Scholar 

  7. Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, et al. Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res. 2014;29(10):2210–6.

    PubMed  PubMed Central  Google Scholar 

  8. Hu ZW, Liu N, Zhou M. Correlation of thoracic kyphosis angle with physical capacity in women with primary osteoporosis. Chin J of Rehabilit Med. 2014;29(12):1124–8. Article in Chinese.

    Google Scholar 

  9. Huang MH, Barrett-Connor E, Greendale GA, Kado DM. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res. 2006;21(3):419–23.

    PubMed  Google Scholar 

  10. Kado DM. Overview of hyperkyphosis in older persons. Available from: https://www.uptodate.com/contents/overview-of-hyperkyphosis-in-older-persons.

  11. Kado DM, Huang MH, Barrett-Connor E, Greendale GA. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study. J Gerontol A Biol Sci Med Sci. 2005;60(5):633–7.

    PubMed  PubMed Central  Google Scholar 

  12. Kado DM, Lui LY, Ensrud KE, Fink HA, Karlamangla AS, Cummings SR. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009;150(10):681–7.

    PubMed  PubMed Central  Google Scholar 

  13. Sangtarash F, Manshadi FD, Sadeghi A. The relationship of thoracic kyphosis to gait performance and quality of life in women with osteoporosis. Osteoporos Int. 2015;26(8):2203–8.

    CAS  PubMed  Google Scholar 

  14. Wu J, Guo K, Yuan F. Pedicle subtraction osteotomy in kyphosis caused by ankylosing spondylitis. Orthop J of Chin. 2015;23(23):2128–32. Article in Chinese.

    Google Scholar 

  15. Jiang Y, Guo ZQ, Chen ZQ. Surgical treatment of thoracolumber kyphosis secondary to old osteoporotic vertebral compression fracture. Orthop J China. 2015;23(14):1249–53. Article in Chinese.

    Google Scholar 

  16. Zhang WJ, Xu XG, Ye JJ. Treatment of severe osteoporotic vertebtal compression fractures with spinal kyphosis. Orthop J Chin. 2016;24(8). Article in Chinese.

  17. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J. 2004;4(4):413–7.

    PubMed  Google Scholar 

  18. Ryan SD, Fried LP. The impact of kyphosis on daily functioning. Aging Clin Exp Res. 1997;45(12):1479–86.

    CAS  Google Scholar 

  19. Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006;1:9–14.

    Google Scholar 

  20. Barrett E, Lenehan B, O’Sullivan K, Lewis J, McCreesh K. Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis. Physiother Theory Pract. 2018;34(4):301–8.

    PubMed  Google Scholar 

  21. Barrett E, McCreesh K, Lewis J. Intrarater and interrater reliability of the flexicurve index, flexicurve angle, and manual inclinometer for the measurement of thoracic kyphosis. Rehabil Res Prac. 2013;2013:475870.

    Google Scholar 

  22. Blommestein ASV, Lewis JS, Morrissey MC, MacRae S. Reliability of measuring thoracic typhosis angle, lumbar lordosis angle and straight leg raise with an inclinometer. The Open Spine J. 2012;4:10–5.

    Google Scholar 

  23. Lewis JS, Valentine RE. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC Musculoskelet Disord. 2010;11:39.

    PubMed  PubMed Central  Google Scholar 

  24. Michikawa T, Nishiwaki Y, Takebayashi T, Toyama Y. One-leg standing test for elderly populations. J Orthop Sci. 2009;14(5):675–85.

    PubMed  Google Scholar 

  25. Bohannon RW, Tudini F. Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data. Physiotherapy. 2018;104(4):376–82.

    PubMed  Google Scholar 

  26. Kamrani AAA, Sani SHZ, Rezaie ZF, Aghdasi MT. Concurrent validity of Functional Gait Assessment, Timed Up and Go, and Gait Speed Tests in the Persian community-dwelling elderly. IRJ. 2010;8(12).

  27. Wall JC, Bell C, Campbell S, Davis J. The Timed Get-up-and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev. 2000;37(1):109–13.

    CAS  PubMed  Google Scholar 

  28. Rodrigues RAS, Teodózio MM, Espinosa MM, Fett WCR, Melo CD, Fett CA. Timed up and go test and self-perceived health in elderly: population-based study. Rev Bras Cineantropom Desempenho Hum. 2018; 20(3): 247–57.

    Google Scholar 

  29. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.

    Google Scholar 

  30. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. PTJ. 2004;84(10):906–18.

    Google Scholar 

  31. Chai Y, Xu M, Liu B, Zhong S. Analysis of prevalence and influencing factors of chronic diseases in the elderly in northwestern Hubei Province. Chin J Chronic Disease Prevention and Control. 2015;23(2):85–8. Article in Chinese.

    Google Scholar 

  32. Liang BT, Huang W. Investigation on the prevalence of chronic diseases in Hubei elderly aged 2015 to 2017 and its influencing factors and prognosis of patients. Chin J Health Education. 2019;4:340–5. Article in Chinese.

    Google Scholar 

  33. Chen J. Survey on prevalence and behavioral factors of major chronic diseases among middle-aged and elderly people in some areas of Hubei Province, Wuhan. [Master thesis]. Wuhan, China: the University of Wuhan; 2005. Thesis in Chinese.

    Google Scholar 

  34. Xiao H, Zhang W, Fang P, Hu K. Health status of empty nest elderly in Jianghan District, Wuhan. Chin Academic J. 2012. Article in Chinese.

  35. Deng HB, Macfarlane DJ, Thomas GN, Lao XQ, Jiang CQ, Cheng KK, et al. Reliability and validity of the IPAQ-Chinese: the Guangzhou Biobank cohort study. Med Sci Sport Exe. 2008;40(2):303–7.

    Google Scholar 

  36. World Health Organization, International Obesity Task Force. The Asian-Pacific perspective: redefining obesity and its treatment. Geneva, Switzerland: WHO Western Pacific Region, 2000.

    Google Scholar 

  37. Ku PW, Steptoe A, Liao Y, Hsueh MC, Chen LJ. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC Medicine. 2018;16(74).

  38. Yue Zhang, Petrini MA. Empty-nest elderly: mahjong and Chinese square dance for improving the cognitive function in the community. Frontiers of Nursing. 2019;6(1).

  39. Tsang W, Wong G, Gao K. Mahjong playing and eye-hand coordination in older adults—a cross-sectional study. J Phys Ther Sci. 2016;28(10):2955–60.

    PubMed  PubMed Central  Google Scholar 

  40. Jung S, Lee NK, Kang KW, Kim K, Lee DY. The effect of smartphone usage time on posture and respiratory function. J Phys Ther Sci. 2016;28(1):186–9.

    PubMed  PubMed Central  Google Scholar 

  41. Forward Industry Research Institute. Report of prospective and investment strategy planning on china information security industry (2019–2024). https://bg.qianzhan.com/. Published December, 2019. Accessed January, 2020.

  42. Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int. 2017;28(10):2831–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Fon GT, Pitt MJ, Thies AC, Jr. Thoracic kyphosis: range in normal subjects. AJR. 1980;134(5):979–83.

    CAS  PubMed  Google Scholar 

  44. Milne JS, Williamson J. A longitudinal study of kyphosis in older people. Age Ageing. 1983;12(3):225–33.

    CAS  PubMed  Google Scholar 

  45. Schneider DL, von Muhlen D, Barrett-Connor E, Sartoris DJ. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol. 2004;31(4):747–52.

    PubMed  Google Scholar 

  46. Wang Y, Tao Y, Hyman ME, Li J, Chen Y. Osteoporosis in China. Osteoporos Int. 2009;20:1651–62.

    CAS  PubMed  Google Scholar 

  47. Mika A. Is there any relationship between decrease in bone mineral density in women and deterioration in quality of life. Med Rehabil. 2005;9(2):15–9.

    Google Scholar 

  48. Kado DM, Huang MH, Karlamangla AS, Cawthon P, Katzman W, Hillier TA, et al. Factors associated with kyphosis progression in older women: 15 years’ experience in the study of osteoporotic fractures. J Bone Miner Res. 2013;28(1):179–87.

    PubMed  PubMed Central  Google Scholar 

  49. Olchowik G, Czwalik A & Kowalczyk B. The changes in postural stability of women in early old age. J Nutr Health Aging. 2020. https://doi.org/10.1007/s12603-020-1399-z

  50. Mignardot JB, Deschamps T, Barrey E, Auvinet B, Berrut G, Cornu C, et al. Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study. Front Aging Neurosci. 2014;6.

  51. Terroso M, Rosa N, Marques AT, Simoes R. Physical consequences of falls in the elderly: a literature review from 1995 to 2010. Eur Rev Aging Phys A. 2014;11:51–9.

    Google Scholar 

Download references

Funding

Funding: Nil

Author information

Authors and Affiliations

Authors

Contributions

Authors contribution: Li, Chau, Dai and Tiwari contributed to the study design, data analysis, results interpretation, and writing the paper. Li also contributed to data collection. All authors contributed to reviewed and approved the final version.

Corresponding author

Correspondence to Pui Hing Chau.

Ethics declarations

Conflict of interest: The authors has no conflicts.

Ethical standards: The study complies with the current laws of the country in which they were performed.

Additional information

Declaration: This study comply with the current laws of China.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, WY., Chau, P.H., Dai, Y. et al. The Prevalence and Negative Effects of Thoracic Hyperkyphosis on Chinese Community-Dwelling Older Adults in Wuhan, Hubei Province, China. J Nutr Health Aging 25, 57–63 (2021). https://doi.org/10.1007/s12603-020-1441-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-020-1441-1

Key words

  • Thoracic hyperkyphosis
  • prevalence
  • negative effects
  • physical performance
  • Chinese old adults