Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study

Alexandra Cours, Mei Hua Huang, Howard Fink, Kristine E. Ensrud, John T Schousboe, Wendy Katzman, Diane Schneider, Nancy E. Lane, Peggy Cawthon, Deborah M. Kado

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Hyperkyphosis commonly affects older people but is not widely acknowledged as a clinically actionable problem, especially in men. There are several techniques to quantify kyphosis including the blocks and Cobb angle measurements. This study includes both kyphosis measures to investigate whether older men with accentuated kyphosis may be at increased mortality risk. Methods: Men aged ≥65 years (N = 5994) were recruited to participate in the MrOS prospective cohort study from 2000 to 2002 (baseline). Our primary cohort included 2931 enrollees (mean age 79.3 years; SD 5.2) who underwent blocks-measured kyphosis from 2006 to 2009. Our secondary cohort included 2351 participants who underwent radiographic Cobb angle measurements at baseline. Cox proportional hazards analyses were used to determine association between kyphosis and all-cause mortality while adjusting for prevalent radiographic vertebral fractures, bone mineral density, incident fractures, gait speed, timed chair stands, self-reported health, alcohol use, medical co-morbidities, and physical activity. Results: During a mean follow-up of 8.3 (SD 3.2) years, 1393 participants died in the primary cohort. In this group, compared to men with 0–1 block kyphosis, increasing blocks-measured kyphosis was associated with increased mortality (HR: 1.26–1.53, p trend <0.001). With addition of prevalent vertebral fracture to adjusted models, the association remained significant in participants with severe kyphosis (3+ blocks-measured). Similarly, with addition of chair stand performance the association remained significant for 4+ blocks kyphosis. Walking speed did not attenuate the association of kyphosis and mortality. In the secondary cohort, there were no significant associations between radiographic Cobb angle kyphosis and mortality. Conclusions: Increasing blocks-measured kyphosis was associated with a greater risk of mortality in older men, indicating that hyperkyphosis identified on physical exam should be considered a clinically significant finding that may warrant further evaluation and treatment.

Original languageEnglish (US)
Pages (from-to)496-504
Number of pages9
JournalJournal of the American Geriatrics Society
Issue number2
StatePublished - Feb 2023

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Institute on Aging (NIA) provided funding for Deborah Kado's grant “Causes and Consequences of Hyperkyphosis in Older Persons” (R01 AG024246).

Publisher Copyright:
© 2022 The American Geriatrics Society.


  • hyper
  • kyphosis
  • mortality

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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