Patterns of menopausal hormone therapy use and hyperkyphosis in older women

Gina N. Woods, Mei Hua Huang, Peggy M. Cawthon, Corinne McDaniels-Davidson, Howard A. Fink, Deborah M. Kado

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Hyperkyphosis, an exaggerated anterior curvature of the thoracic spine, is associated with poor physical function, falls, fractures, and earlier mortality. Low bone mineral density, bone loss, and vertebral fractures are strong risk factors for hyperkyphosis. Menopausal hormone therapy (HT) reverses bone loss, prevents vertebral fractures, and, therefore, we hypothesize, may reduce the risk for developing hyperkyphosis. Methods: We evaluated the cross-sectional association between Cobb angle of kyphosis from lateral spine radiographs and pattern of self-reported HT use during the prior 15-year period in 1,063 women from the Study of Osteoporotic Fractures. Results: Participants had a mean age of 83.7±3.3 years and a mean Cobb angle of 51.3±14.6°. Forty-six per cent of women were characterized as never-users of HT, 24% as remote past users, 17% as intermittent users, and 12% as continuous users. In minimally adjusted models, the mean Cobb angle was 4.0° less in continuous HT users compared with never-users (P=0.01); however, in fully adjusted models, this association was attenuated to 2.8° (P=0.06). Remote past HT users had 3.0° less kyphosis compared with never-users in minimally adjusted models (P=0.01), attenuated to 2.8° less in fully adjusted models (P=0.02). Intermittent users did not differ from never-users in degree of kyphosis. Conclusions: Women reporting continuous or remote past HT use had less pronounced kyphosis than never-users by their mid-eighties, suggesting a possible role for HT in the prevention of age-related hyperkyphosis.

Original languageEnglish (US)
Pages (from-to)738-743
Number of pages6
Issue number7
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
Received November 12, 2017; revised and accepted January 3, 2018. From the 1University of California, San Diego, La Jolla, CA; 2VA San Diego Healthcare System, San Diego, CA; 3David Geffen School of Medicine at UCLA, Los Angeles, CA; 4California Pacific Medical Center Research Institute, San Francisco, CA; 5Geriatric Research Education and Clinical Center, Veterans Affairs Health Care Center, Minneapolis, MN; 6Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care Center, Minneapolis, MN; and 7Department of Medicine, and Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, MN. Funding/support: The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, R01 AG026720. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Gina N. Woods, MD, 3350 La Jolla Village Drive, 111G, San Diego, CA 92161. E-mail:

Publisher Copyright:
© 2018 by The North American Menopause Society.


  • Aging
  • Hormone therapy
  • Kyphosis
  • Menopause
  • Vertebral fracture


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