A new North American study found that women who are continuous or remote users menopausal hormone therapy have less evident kyphosis in their mid-eighties as compared to never users. The study is published ahead of print on February 16, 2018, in menopausal society journal Menopause.
Age-related hyperkyphosis is exaggerated anterior curvature of the spine is common in men and post-menopausal women and is associated with increased bone loss, degenerative disc diseases, and vertical compression fractures. It causes difficulty in performing activities of daily living and reduces the quality of life.
The Women’s Health Initiative study has also shown that hormone therapy (HT) reduces the odds of vertebral fractures. Based on the same hypothesis, this study also confirmed the protective effect of HT against the development of kyphosis or dowager’s hump.
The significant decline in estrogen levels after menopause results in accelerated bone loss resulting in the compression fracture of the vertebra. After a woman is put on HT, bone loss increases steadily in 3 years and is maintained by continuous use.
The authors of this study looked at data from nearly 10,000, community-dwelling women aged 65 and older from the landmark Study of Osteoporotic Fractures (SOF) and followed them for a period of 15 years. This study is a multicentric, observational study started in 1986 and closed after 31 years in September 2017.
Kyphosis was measured by mapping the Cobb angle in lateral radiograph spine and correlated with HT use.
The mean age of study participants was 83.7 ± 3.3 years and a mean Cobb angle of 51.3 ± 14.6°.
Nearly half of the women reported having never used HRT, while 25% reported using it remotely in past, 17% reported that they used HT intermittently while only 12% reported continuous use.
After accounting for confounders, women who used HT in remote past and continuous users had nearly 3.0° less kyphosis compared with never users. Intermittent use did not confer any protection and the women had the same Cobb angle as never users.
The SOF findings also showed that women who lose more than two inches in height have an increased risk for fracture and early death.
NAMS executive director Dr. JoAnn Pinkerton concluded, “Women who reported the early use of HT were less likely to develop age-related kyphosis, and the protective benefits continued even after stopping HT. This supports a benefit of prescribing HT close to menopause.”
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