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Relationship Between Kyphotic Posture and Falls in Community-Dwelling Men and Women

The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

Tominaga, Ryoji MD; Fukuma, Shingo MD, PhD†,‡; Yamazaki, Shin PhD†,§; Sekiguchi, Miho MD, PhD; Otani, Koji MD, DMSc; Kikuchi, Shin-ichi MD, PhD; Sasaki, Sho MD; Kobayashi, Susumu MD; Fukuhara, Shunichi MD, PhD†,‡; Konno, Shin-ichi MD, PhD

doi: 10.1097/BRS.0000000000001602

Study Design. A cohort study using data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study, a population-based prospective cohort study of residents of the towns of Tadami and Minamiaizu in Fukushima Prefecture, Japan.

Objective. The aim of this study was to clarify the association between kyphotic posture and falls, and to investigate the presence or absence of sex differences.

Summary of Background Data. In our literature review, we found no studies focusing on sex differences in the association between kyphotic posture and falls.

Methods. We included subjects aged more than 40 years who participated in annual health check-ups from 2009 to 2010. We analyzed the effects of kyphotic posture, measured using the wall-occiput test (WOT), on falls, adjusting for potential confounders, such as age, body mass index, symptoms of depression, sedative medication, and other comorbidities.

Results. We enrolled a total of 1418 subjects into primary analyses (593 men, 825 women; mean [standard deviation] age, 68.1 [7.7] yrs). We then stratified subjects into the following groups according to the degree of kyphotic posture: nonkyphotic posture (n = 1138, 80.3%), mild kyphotic posture (n = 172, 12.1%), and severe kyphotic posture (n = 108, 7.6%). We observed no significant difference in the severity of kyphotic posture between men and women (P = 0.18). Overall, 284 subjects (20.0%) experienced at least one fall during the one-year period. After adjustment for potential confounders using a logistic regression model, we observed a significant association between severe kyphotic posture and falls for men [odds ratio (OR) 2.14 (1.01–4.57); P = 0.048]. In contrast, we observed no significant association for women [OR for severe kyphotic posture 0.80 (0.43–1.50), OR for mild kyphotic posture 0.91 (0.53–1.57)].

Conclusion. We identified a sex difference in the association between kyphotic posture and falls in community-dwelling adults. In particular, severe kyphotic posture might only increase the incidence of falls in men.

Level of Evidence: 3

Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University

Department of Healthcare Epidemiology, Kyoto University School of Public Health

Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University

§Center for Environmental Health Science, National Institute for Environmental Studies, Tsukuba, Japan.

Address correspondence and reprint requests to Shingo Fukuma, MD, PhD, Department of Healthcare Epidemiology, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; E-mail:

Received 14 October, 2015

Revised 15 January, 2016

Accepted 26 February, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

This study was supported by grants from the Institute for Health Outcomes and Process Evaluation Research (iHope International), the Fukushima Society for the Promotion of Medicine, and Fukushima Prefectural Hospital.

No relevant financial activities outside the submitted work.

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