From the Guidelines
The treatment for Dowager's hump (kyphosis) caused by osteoporosis should prioritize bisphosphonates, such as alendronate or risedronate, as first-line therapy to reduce fracture risk and slow bone loss, as recommended by the American College of Physicians 1.
Key Considerations
- The goal of treatment is to reduce the risk of fractures, manage pain, and improve quality of life.
- Bisphosphonates, such as alendronate (70mg weekly) or risedronate (35mg weekly), are effective in reducing vertebral and nonvertebral fracture risk 1.
- Denosumab is an alternative option for patients who cannot tolerate bisphosphonates or have a high risk of fracture 1.
- Physical therapy, including extension exercises, posture training, and core strengthening, is essential for managing the kyphotic deformity.
- Vitamin D (800-1000 IU daily) and calcium supplementation (1000-1200mg daily) are crucial for supporting bone health.
Additional Therapies
- Bracing may be recommended to provide support and improve posture.
- Pain management may include over-the-counter analgesics like acetaminophen or NSAIDs.
- In severe cases, surgical interventions like vertebroplasty, kyphoplasty, or spinal fusion may be necessary.
Prevention Strategies
- Fall prevention, smoking cessation, and limiting alcohol intake are essential to prevent worsening of the condition.
- Maintaining proper posture during daily activities can help prevent further kyphosis.
Evidence-Based Recommendations
- The American College of Physicians recommends offering pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women with known osteoporosis 1.
- The EULAR/EFORT recommendations suggest using drugs that have been demonstrated to reduce the risk of vertebral, non-vertebral, and hip fractures, and regularly monitoring for tolerance and adherence 1.
From the FDA Drug Label
Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture Alendronate reduces bone resorption with no direct effect on bone formation, although the latter process is ultimately reduced because bone resorption and formation are coupled during bone turnover In osteoporosis treatment studies alendronate sodium 10 mg/day decreased the markers of bone formation, osteocalcin and bone specific alkaline phosphatase by approximately 50%, and total serum alkaline phosphatase by approximately 25 to 30% to reach a plateau after 6 to 12 months
The treatment for Dowager's hump (kyphosis) caused by osteoporosis is alendronate sodium, which reduces bone resorption and increases bone mass.
- Key benefits of alendronate sodium include:
- Reduction of bone resorption
- Increase in bone mass
- Decrease in markers of bone formation
- Dosage: 10 mg/day, or 70 mg once weekly 2
- Important note: Alendronate sodium should be continuously administered to suppress osteoclasts on newly formed resorption surfaces.
- Alternatively, denosumab can be used to treat osteoporosis in postmenopausal women at high risk for fracture, with a recommended dose of 60 mg administered as a single subcutaneous injection once every 6 months 3
From the Research
Treatment for Dowager's Hump (Kyphosis) Caused by Osteoporosis
- The treatment for Dowager's hump, also known as kyphosis, caused by osteoporosis can involve a combination of non-pharmacological and pharmacological interventions 4, 5, 6, 7, 8.
- Non-pharmacological treatments include chiropractic care, which has been shown to improve symptoms and function in patients with Dowager's hump 4.
- Pharmacological treatments for osteoporosis, such as bisphosphonates (e.g. alendronate), vitamin D, and calcium supplementation, can help prevent fractures and reduce the risk of kyphosis progression 5, 6, 7, 8.
- A study found that alendronate, vitamin D, and calcium supplementation increased lumbar spine bone mineral density by 5.2% in patients with HIV infection-related osteopenia/osteoporosis 5.
- Another study found that calcium plus vitamin D supplementation reduced the risk of total fractures by 15% and hip fractures by 30% in adults 7.
- A systematic review and meta-analysis found that the combination of vitamin D and calcium reduced total fractures and hip fractures, while being well-tolerated with minor side effects 8.
- Maintaining correct posture and avoiding forward head flexion are also important mechanisms to prevent the reoccurrence of Dowager's hump 4.
Non-Pharmacological Interventions
- Chiropractic care, including manipulative correction of spinal alignment, can improve symptoms and function in patients with Dowager's hump 4.
- Exercise and multifactorial non-pharmacological interventions can also be beneficial in preventing fractures and reducing the risk of kyphosis progression 6.