TRIP

In a patient aged over 80 should bisphosphonates be prescribed for kyphosis that is suspected but not confirmed as arising from osteoporosis?

TRIP Answers, 2012

In a patient aged over 80 should bisphosphonates be prescribed for kyphosis that is suspected but not confirmed as arising from osteoporosis?
In a patient aged over 80 should bisphosphonates be prescribed for kyphosis that is suspected but not confirmed as arising from osteoporosis?
ATTRACT found no randomized controlled trials examining the use of bisphosphonates in patients with kyphosis nor guidance on the prescription of these drugs in this condition.2010 guidance on osteoporosis from Prodigy outlines the parameters for diagnosis of osteoporosis and management thereof (1).
“If there is kyphosis (curvature of the spine), loss of height (more than 2 inches), or unexplained back pain, consider lateral X-ray of the spine to detect wedge and crush fractures.”
ATTRACT found little additional relevant information from a Pubmed search of this topic; 4 abstracts may be of interest and these are reproduced below (2-5):
We examined the association of radiographically defined kyphosis with vertebral fractures to determine if this belief was true.
METHODS: A total of 1407 ambulatory white adults, aged 50-96 years, from the middle-class community of Rancho Bernardo, California, USA, attended a 1992-96 research clinic visit.
Bone mineral density (BMD) was measured at the hip and spine, and lateral thoracolumbar spine radiographs were obtained.
RESULTS: A total of 114 of 553 men (20.6%) and 188 of 854 women (22.0%) had one or more thoracic vertebral fractures.
The mean age-adjusted Cobb angle was significantly higher (p or = 55.5 degrees ), only 36.2% of men and 36.9% of women had prevalent thoracic vertebral fractures; and osteoporosis using WHO BMD criteria was present at the total hip in 9.7% of men and 32.7% of women.
CONCLUSION: The majority of men and women with exaggerated kyphosis (the upper quartile of the Cobb angle) had no evidence of thoracic vertebral fractures or osteoporosis.