Kyphosis

Also called Hunchback, Dowager's hump, Round back

An exaggerated forward curve of the upper spine. In an older person it usually means spinal fractures nobody knew about.

What it is

An excessive forward curve of the upper spine, producing a rounded or hunched back.

The causes differ completely by age, and so does the significance.

**In older people**, the commonest cause is osteoporosis with vertebral compression fractures. This is the important one, because those fractures are frequently silent: only around a third cause noticeable pain, and the rest show up only as height loss and an increasing stoop. **An older person who has lost height or developed a stoop should be assessed for osteoporosis**, because they have almost certainly had fractures and are at high risk of more, including a hip fracture, which osteoporosis treatment substantially prevents.

**In adolescents**, Scheuermann's disease causes a rigid structural curve, distinct from postural round-back, which corrects when the person is asked to stand straight.

Severe kyphosis has real consequences: reduced lung capacity and breathlessness, difficulty looking forwards, reflux, early satiety and weight loss, pressure on the abdomen, balance problems and falls.

Treatment is directed at the cause: osteoporosis treatment, physiotherapy and back extensor strengthening, and, rarely, surgery.

Signs you might notice

A rounded upper back, worse over time.

Loss of height, often several centimetres.

A stoop that cannot be corrected by standing up straight, in structural kyphosis.

Back pain and stiffness.

Difficulty looking straight ahead, and difficulty lying flat.

Breathlessness on exertion in severe curves.

Early fullness when eating, and reflux.

Urgent: new severe back pain in an older person, which may be an acute vertebral fracture; and any weakness, numbness, or bladder or bowel change, which suggests spinal cord compression and is an emergency.

In a child or teenager: a rigid curve, pain, or a curve that is progressing, all needing assessment.

How it can affect day-to-day life

Height loss is the most useful and most neglected measurement in older people's health. Measuring height at reviews, and comparing with the recorded height from earlier life, identifies people who need bone assessment.

The appearance change matters to people and is rarely acknowledged. It affects confidence, clothing and how others treat them.

The forward head position pushes the centre of gravity forwards and increases falls risk substantially, and back extensor strengthening improves both posture and balance.

Eating small frequent meals helps where the abdomen is compressed, and reflux is common.

Correct pain management after acute vertebral fracture matters: opioids cause constipation, confusion and falls in this group, and early mobilisation with adequate analgesia is better than bed rest.

For teenagers, the distinction between postural and structural kyphosis determines everything, and postural round-back responds well to exercise.

Supporting someone well

Measure height, and compare it with earlier recorded height. Loss is a red flag.

Ask for a bone density scan and osteoporosis assessment for any older person with a new stoop or height loss.

Ask about a Fracture Liaison Service.

Ask for physiotherapy focused on back extensor strengthening and balance.

Get new severe back pain in an older person assessed; do not assume it is muscular.

Treat cord compression symptoms as an emergency.

Manage pain adequately but watch opioid side effects in older people.

Optimise calcium, vitamin D, and take osteoporosis treatment.

In a teenager, ask whether the curve corrects on standing straight; that determines the diagnosis.

Where to get help

A GP practice for height measurement, bone assessment and physiotherapy referral.

A Fracture Liaison Service or metabolic bone clinic.

999 or urgent referral for weakness, numbness or continence changes with back pain.

Royal Osteoporosis Society run a helpline and cover spinal fractures.