Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Overview of hyperkyphosis in older persons

Deborah M Kado, MD, MS
Section Editor
Kenneth E Schmader, MD
Deputy Editor
Howard Libman, MD


Hyperkyphosis is excessive curvature of the thoracic spine, commonly known as the "dowager's hump." Although it is also referred to as kyphosis, the term kyphosis is meant to describe the sagittal convexity, or forward curvature, of the normal thoracic spine which can range from normal to abnormal. Kyphosis tends to progress with age [1].

The evaluation and treatment of hyperkyphosis is challenging due to the lack of standardized diagnostic criteria and evidence-based treatment options. Within the last several years, exercise programs, spinal orthotics, and other interventions have been studied that may help delay the progression of age-related kyphosis. However, stronger evidence of efficacy with improved clinical outcomes is needed prior to widespread use of many of these interventions.

This topic will focus on the etiology, evaluation, and management of hyperkyphosis in older adults. Hyperkyphosis in children and adolescents is discussed separately. (See "Back pain in children and adolescents: Overview of causes".)


There is no widely accepted definition of hyperkyphosis, and therefore the prevalence of hyperkyphosis in older persons is not precisely known. Estimates range between 20 and 40 percent among community-dwelling individuals aged ≥60 years [2-4].

The prevalence of hyperkyphosis increases with age, with the greatest change in the angle of kyphosis occurring among women age 50 to 59 years [5].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Mon Jan 23 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Milne JS, Lauder IJ. Age effects in kyphosis and lordosis in adults. Ann Hum Biol 1974; 1:327.
  2. Kado DM, Huang MH, Karlamangla AS, et al. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. J Am Geriatr Soc 2004; 52:1662.
  3. Ryan SD, Fried LP. The impact of kyphosis on daily functioning. J Am Geriatr Soc 1997; 45:1479.
  4. Takahashi T, Ishida K, Hirose D, et al. Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people. Osteoporos Int 2005; 16:273.
  5. Ball JM, Cagle P, Johnson BE, et al. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int 2009; 20:481.
  6. Schneider DL, von Mühlen D, Barrett-Connor E, Sartoris DJ. Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol 2004; 31:747.
  7. Ensrud KE, Black DM, Harris F, et al. Correlates of kyphosis in older women. The Fracture Intervention Trial Research Group. J Am Geriatr Soc 1997; 45:682.
  8. Lyles KW, Gold DT, Shipp KM, et al. Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 1993; 94:595.
  9. Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159:1215.
  10. Siminoski K, Warshawski RS, Jen H, Lee KC. The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures. J Musculoskelet Neuronal Interact 2011; 11:249.
  11. Kado DM, Huang MH, Karlamangla AS, et al. Factors associated with kyphosis progression in older women: 15 years' experience in the study of osteoporotic fractures. J Bone Miner Res 2013; 28:179.
  12. Katzman WB, Vittinghoff E, Kado DM, et al. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int 2016; 27:899.
  13. Okamoto Y, Murakami H, Demura S, et al. The effect of kyphotic deformity because of vertebral fracture: a finite element analysis of a 10° and 20° wedge-shaped vertebral fracture model. Spine J 2015; 15:713.
  14. Bruno AG, Anderson DE, D'Agostino J, Bouxsein ML. The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading. J Bone Miner Res 2012; 27:2144.
  15. Pavlovic A, Nichols DL, Sanborn CF, Dimarco NM. Relationship of thoracic kyphosis and lumbar lordosis to bone mineral density in women. Osteoporos Int 2013; 24:2269.
  16. McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet 1992; 29:41.
  17. Axenovich TI, Zaidman AM, Zorkoltseva IV, et al. Segregation analysis of Scheuermann disease in ninety families from Siberia. Am J Med Genet 2001; 100:275.
  18. Graat HC, van Rhijn LW, Schrander-Stumpel CT, van Ooij A. Classical Scheuermann disease in male monozygotic twins: further support for the genetic etiology hypothesis. Spine (Phila Pa 1976) 2002; 27:E485.
  19. Findlay A, Conner AN, Connor JM. Dominant inheritance of Scheuermann's juvenile kyphosis. J Med Genet 1989; 26:400.
  20. Goh S, Price RI, Leedman PJ, Singer KP. The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis. Clin Biomech (Bristol, Avon) 1999; 14:439.
  21. Stone MA, Osei-Bordom DC, Inman RD, et al. Heritability of spinal curvature and its relationship to disc degeneration and bone mineral density in female adult twins. Eur Spine J 2015; 24:2387.
  22. Boyle JJ, Milne N, Singer KP. Influence of age on cervicothoracic spinal curvature: an ex vivo radiographic survey. Clin Biomech (Bristol, Avon) 2002; 17:361.
  23. Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 2005; 87:260.
  24. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J 2004; 4:413.
  25. Mika A, Unnithan VB, Mika P. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 2005; 30:241.
  26. Sinaki M, Itoi E, Rogers JW, et al. Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. Am J Phys Med Rehabil 1996; 75:370.
  27. Sinaki M, Wollan PC, Scott RW, Gelczer RK. Can strong back extensors prevent vertebral fractures in women with osteoporosis? Mayo Clin Proc 1996; 71:951.
  28. Sinaki M, Brey RH, Hughes CA, et al. Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 2005; 16:1004.
  29. Brocklehurst JC, Robertson D, James-Groom P. Skeletal deformities in the elderly and their effect on postural sway. J Am Geriatr Soc 1982; 30:534.
  30. Chow RK, Harrison JE. Relationship of kyphosis to physical fitness and bone mass on post-menopausal women. Am J Phys Med 1987; 66:219.
  31. Granito RN, Aveiro MC, Renno AC, et al. Comparison of thoracic kyphosis degree, trunk muscle strength and joint position sense among healthy and osteoporotic elderly women: a cross-sectional preliminary study. Arch Gerontol Geriatr 2012; 54:e199.
  32. Katzman WB, Miller-Martinez D, Marshall LM, et al. Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group. BMC Musculoskelet Disord 2014; 15:19.
  33. Miyakoshi N, Hongo M, Maekawa S, et al. Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporos Int 2005; 16:1871.
  34. Eagan MS, Sedlock DA. Kyphosis in active and sedentary postmenopausal women. Med Sci Sports Exerc 2001; 33:688.
  35. Hongo M, Miyakoshi N, Shimada Y, Sinaki M. Association of spinal curve deformity and back extensor strength in elderly women with osteoporosis in Japan and the United States. Osteoporos Int 2012; 23:1029.
  36. Katzman W, Cawthon P, Hicks GE, et al. Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women. J Gerontol A Biol Sci Med Sci 2012; 67:191.
  37. Resnick D. Degenerative diseases of the vertebral column. Radiology 1985; 156:3.
  38. Birnbaum K, Siebert CH, Hinkelmann J, et al. Correction of kyphotic deformity before and after transection of the anterior longitudinal ligament--a cadaver study. Arch Orthop Trauma Surg 2001; 121:142.
  39. Nardo L, Lane NE, Parimi N, et al. Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study. Spine (Phila Pa 1976) 2014; 39:E1418.
  40. Katzman WB, Parimi N, Mansoori Z, et al. Cross-sectional and Longitudinal Associations of Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Thoracic Kyphosis in Older Men and Women. Arthritis Care Res (Hoboken) 2016.
  41. Yau MS, Demissie S, Zhou Y, et al. Heritability of Thoracic Spine Curvature and Genetic Correlations With Other Spine Traits: The Framingham Study. J Bone Miner Res 2016; 31:2077.
  42. Kuro-o M, Matsumura Y, Aizawa H, et al. Mutation of the mouse klotho gene leads to a syndrome resembling ageing. Nature 1997; 390:45.
  43. Vogel H, Lim DS, Karsenty G, et al. Deletion of Ku86 causes early onset of senescence in mice. Proc Natl Acad Sci U S A 1999; 96:10770.
  44. Tyner SD, Venkatachalam S, Choi J, et al. p53 mutant mice that display early ageing-associated phenotypes. Nature 2002; 415:45.
  45. de Boer J, Andressoo JO, de Wit J, et al. Premature aging in mice deficient in DNA repair and transcription. Science 2002; 296:1276.
  46. Cho SK, Shin JI, Kim YJ. Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J 2014; 23:2726.
  47. Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR. Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone Miner Res 2007; 22:447.
  48. Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990; 141:68.
  49. Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998; 8:261.
  50. Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine (Phila Pa 1976) 1994; 19:1250.
  51. Lombardi I Jr, Oliveira LM, Mayer AF, et al. Evaluation of pulmonary function and quality of life in women with osteoporosis. Osteoporos Int 2005; 16:1247.
  52. Di Bari M, Chiarlone M, Matteuzzi D, et al. Thoracic kyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy. J Am Geriatr Soc 2004; 52:909.
  53. Ordu Gokkaya NK, Koseoglu F, Albayrak N. Reduced aerobic capacity in patients with severe osteoporosis: a cross sectional study. Eur J Phys Rehabil Med 2008; 44:141.
  54. Lorbergs AL, O'Connor GT, Zhou Y, et al. Severity of Kyphosis and Decline in Lung Function: The Framingham Study. J Gerontol A Biol Sci Med Sci 2016.
  55. Ryan PJ, Blake G, Herd R, Fogelman I. A clinical profile of back pain and disability in patients with spinal osteoporosis. Bone 1994; 15:27.
  56. Cortet B, Houvenagel E, Puisieux F, et al. Spinal curvatures and quality of life in women with vertebral fractures secondary to osteoporosis. Spine (Phila Pa 1976) 1999; 24:1921.
  57. Lombardi I Jr, Oliveira LM, Monteiro CR, et al. Evaluation of physical capacity and quality of life in osteoporotic women. Osteoporos Int 2004; 15:80.
  58. Hirose D, Ishida K, Nagano Y, et al. Posture of the trunk in the sagittal plane is associated with gait in community-dwelling elderly population. Clin Biomech (Bristol, Avon) 2004; 19:57.
  59. 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; 60:633.
  60. Antonelli-Incalzi R, Pedone C, Cesari M, et al. Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study. Aging Clin Exp Res 2007; 19:207.
  61. 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; 22:85.
  62. Katzman WB, Harrison SL, Fink HA, et al. Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci 2015; 70:635.
  63. Katzman WB, Vittinghoff E, Ensrud K, et al. Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study. J Am Geriatr Soc 2011; 59:96.
  64. Katzman WB, Huang MH, Lane NE, et al. Kyphosis and decline in physical function over 15 years in older community-dwelling women: the Study of Osteoporotic Fractures. J Gerontol A Biol Sci Med Sci 2013; 68:976.
  65. Lynn SG, Sinaki M, Westerlind KC. Balance characteristics of persons with osteoporosis. Arch Phys Med Rehabil 1997; 78:273.
  66. de Groot MH, van der Jagt-Willems HC, van Campen JP, et al. Testing postural control among various osteoporotic patient groups: a literature review. Geriatr Gerontol Int 2012; 12:573.
  67. Greig AM, Bennell KL, Briggs AM, et al. Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis. Osteoporos Int 2007; 18:543.
  68. Eum R, Leveille SG, Kiely DK, et al. Is kyphosis related to mobility, balance, and disability? Am J Phys Med Rehabil 2013; 92:980.
  69. de Groot MH, van der Jagt-Willems HC, van Campen JP, et al. A flexed posture in elderly patients is associated with impairments in postural control during walking. Gait Posture 2014; 39:767.
  70. Kasukawa Y, Miyakoshi N, Hongo M, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010; 28:82.
  71. Woodhull-McNeal AP. Changes in posture and balance with age. Aging (Milano) 1992; 4:219.
  72. O'Brien K, Culham E, Pickles B. Balance and skeletal alignment in a group of elderly female fallers and nonfallers. J Gerontol A Biol Sci Med Sci 1997; 52:B221.
  73. Arnold CM, Busch AJ, Schachter CL, et al. The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis. J Orthop Sports Phys Ther 2005; 35:452.
  74. Kado DM, Huang MH, Nguyen CB, et al. Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study. J Gerontol A Biol Sci Med Sci 2007; 62:652.
  75. Milne JS, Williamson J. A longitudinal study of kyphosis in older people. Age Ageing 1983; 12:225.
  76. De Smet AA, Robinson RG, Johnson BE, Lukert BP. Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. Radiology 1988; 166:497.
  77. Puche RC, Morosano M, Masoni A, et al. The natural history of kyphosis in postmenopausal women. Bone 1995; 17:239.
  78. McGrother CW, Donaldson MM, Clayton D, et al. Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Osteoporos Int 2002; 13:89.
  79. Porter RW, Johnson K, McCutchan JD. Wrist fracture, heel bone density and thoracic kyphosis: a case control study. Bone 1990; 11:211.
  80. 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; 21:419.
  81. Kado DM, Miller-Martinez D, Lui LY, 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; 29:2210.
  82. Ettinger B, Black DM, Palermo L, et al. Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures. Osteoporos Int 1994; 4:55.
  83. Cooper KL. Insufficiency fractures of the sternum: a consequence of thoracic kyphosis? Radiology 1988; 167:471.
  84. Klaase JM, Zimmerman KW, Veldhuis EF. Increased kyphosis by a combination of fractures of the sternum and thoracic spine. Eur Spine J 1998; 7:69.
  85. Blechacz B, Gajic O. Images in clinical medicine. Severe kyphosis. N Engl J Med 2008; 358:e28.
  86. Kusano M, Hashizume K, Ehara Y, et al. Size of hiatus hernia correlates with severity of kyphosis, not with obesity, in elderly Japanese women. J Clin Gastroenterol 2008; 42:345.
  87. Furukawa N, Iwakiri R, Koyama T, et al. Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol 1999; 34:441.
  88. Polomsky M, Siddall KA, Salvador R, et al. Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis. J Am Coll Surg 2009; 208:562.
  89. Uno G, Amano Y, Yuki T, et al. Relationship between kyphosis and Barrett's esophagus in Japanese patients. Intern Med 2011; 50:2725.
  90. Lind LR, Lucente V, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol 1996; 87:605.
  91. Mattox TF, Lucente V, McIntyre P, et al. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000; 183:1381.
  92. Martin AR, Sornay-Rendu E, Chandler JM, et al. The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 2002; 31:32.
  93. Wankie C, Kritz-Silverstein D, Barrett-Connor E, Kado DM. Kyphosis and sleep characteristics in older persons: The Rancho Bernardo Study. J Sleep Disord Manag 2015; 1:1.
  94. Kado DM, Lui LY, Ensrud KE, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med 2009; 150:681.
  95. Lundon KM, Li AM, Bibershtein S. Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis. Spine (Phila Pa 1976) 1998; 23:1978.
  96. Leidig-Bruckner G, Minne HW, Schlaich C, et al. Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 1997; 12:663.
  97. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med 2007; 147:330.
  98. Fon GT, Pitt MJ, Thies AC Jr. Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol 1980; 134:979.
  99. Boseker EH, Moe JH, Winter RB, Koop SE. Determination of "normal" thoracic kyphosis: a roentgenographic study of 121 "normal" children. J Pediatr Orthop 2000; 20:796.
  100. Cortet B, Roches E, Logier R, et al. Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. Joint Bone Spine 2002; 69:201.
  101. Manns RA, Haddaway MJ, McCall IW, et al. The relative contribution of disc and vertebral morphometry to the angle of kyphosis in asymptomatic subjects. Clin Radiol 1996; 51:258.
  102. Sidhu LS, Singal P. Age changes in kyphosis and lordosis of Jat-Sikh and Bania females of Punjab (India) from 20 to 80 years. Anthropol Anz 1983; 41:59.
  103. Singer KP, Jones TJ, Breidahl PD. A comparison of radiographic and computer-assisted measurements of thoracic and thoracolumbar sagittal curvature. Skeletal Radiol 1990; 19:21.
  104. Schenkman M, Shipp KM, Chandler J, et al. Relationships between mobility of axial structures and physical performance. Phys Ther 1996; 76:276.
  105. Korovessis PG, Stamatakis MV, Baikousis AG. Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine (Phila Pa 1976) 1998; 23:700.
  106. Tüzün C, Yorulmaz I, Cindaş A, Vatan S. Low back pain and posture. Clin Rheumatol 1999; 18:308.
  107. Bartynski WS, Heller MT, Grahovac SZ, et al. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol 2005; 26:2077.
  108. Ostrowska B, Rozek-Mróz K, Giemza C. Body posture in elderly, physically active males. Aging Male 2003; 6:222.
  109. Drzał-Grabiec J, Snela S, Rykała J, et al. Changes in the body posture of women occurring with age. BMC Geriatr 2013; 13:108.
  110. Greendale GA, McDivit A, Carpenter A, et al. Yoga for women with hyperkyphosis: results of a pilot study. Am J Public Health 2002; 92:1611.
  111. Katzman WB, Sellmeyer DE, Stewart AL, et al. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil 2007; 88:192.
  112. Hedlund LR, Gallagher JC. Vertebral morphometry in diagnosis of spinal fractures. Bone Miner 1988; 5:59.
  113. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil 2014; 95:129.
  114. Benedetti MG, Berti L, Presti C, et al. Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment. J Neuroeng Rehabil 2008; 5:32.
  115. Morey MC, Schenkman M, Studenski SA, et al. Spinal-flexibility-plus-aerobic versus aerobic-only training: effect of a randomized clinical trial on function in at-risk older adults. J Gerontol A Biol Sci Med Sci 1999; 54:M335.
  116. Itoi E, Sinaki M. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc 1994; 69:1054.
  117. Greendale GA, Huang MH, Karlamangla AS, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 2009; 57:1569.
  118. Pawlowsky SB, Hamel KA, Katzman WB. Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women. Arch Phys Med Rehabil 2009; 90:358.
  119. Renno, ACM GR, Driusso, P, Costa, D, Oishi, J. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study. Physiotherapy 2005; 91:113.
  120. Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil 2004; 83:177.
  121. Vogt L, Hübscher M, Brettmann K, et al. Postural correction by osteoporosis orthosis (Osteo-med): a randomized, placebo-controlled trial. Prosthet Orthot Int 2008; 32:103.
  122. Pfeifer M, Kohlwey L, Begerow B, Minne HW. Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil 2011; 90:805.
  123. Sinaki M, Brey RH, Hughes CA, et al. Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program. Mayo Clin Proc 2005; 80:849.
  124. Greig AM, Bennell KL, Briggs AM, Hodges PW. Postural taping decreases thoracic kyphosis but does not influence trunk muscle electromyographic activity or balance in women with osteoporosis. Man Ther 2008; 13:249.
  125. Kamali F, Shirazi SA, Ebrahimi S, et al. Comparison of manual therapy and exercise therapy for postural hyperkyphosis: A randomized clinical trial. Physiother Theory Pract 2016; 32:92.
  126. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280:2077.
  127. Kado, DM, Huan, MH, Barrett-Conner, E, et al. Does Alendronate Use Prevent Kyphosis Progression in Older Women? J Bone Miner Res 2008; 23:S209.
  128. Roux C, Fechtenbaum J, Kolta S, et al. Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Miner Res 2010; 25:362.
  129. Ailon T, Shaffrey CI, Lenke LG, et al. Progressive Spinal Kyphosis in the Aging Population. Neurosurgery 2015; 77 Suppl 4:S164.
  130. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009; 361:557.
  131. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009; 361:569.
  132. Staples MP, Kallmes DF, Comstock BA, et al. Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. BMJ 2011; 343:d3952.
  133. Preventing kyphosis. Reducing your risk of getting a hunched back. Mayo Clin Health Lett 2008; 26:7.
  134. Standing tall. Exercises can help with the bad posture and osteoporosis that cause us to stoop and lose height as we get older. Harv Health Lett 2005; 31:1.