Relationships between falls, vertebral fractures, increased kyphosis and a flexed posture in elderly: a prospective cohort study

Introduction: Vertebral fractures, thoracic kyphosis and flexed posture are associated with reported falls in cohort studies with elderly, but not yet confirmed as a risk factor in a prospective study. The purpose of the present study was to investigate whether elderly patients with vertebral fractures, hyperkyphosis or flexed posture experience more fall incidents than patients without these clinical entities. Methods: Patients were recruited in a geriatric hospital outpatient clinic and included if they could walk independently for 3 minutes without an asymmetric walking pattern. Lateral radiographs of the spine were taken to evaluate vertebral fractures with the semi‐ quantitative method of Genant, and to assess the degree of thoracic kyphosis using the Cobb angle: hyperkyphosis was defined as Cobb angle ≥50°. A flexed posture was measured by the occiput‐to‐wall distance. Self‐reported falls were prospectively registered by monthly phone contact for the duration of 12 months. Results: Fifty‐one patients were included; mean age was 79 years (SD=4.8). Hyperkyphosis was a strong independent risk factor for falling with an OR of 6.18 (95% CI: 1.17‐32.74). Prevalent vertebral fractures had a trend towards significancy (p=0.06). Flexed posture was not significantly associated with prospective falling. Conclusion: Elderly patients with hyperkyphosis (Cobb angle ≥50°) are more likely to fall within the next year. We recommend implementing hyperkyphosis in fall‐risk assessments. Because vertebral fractures can contribute to hyperkyphosis and are usually the result of osteoporosis, falls in these patients raises the risk of a new fracture. The finding of vertebral fractures and particularly hyperkyphosis should alert physicians to start anti‐osteoporotic therapy.