Kyphosis

Osteoporosis is a disabling disorder with enormous impact. In addition to the initial pain associated with a new fracture, several adverse long-term complications can occur, including chronic pain, loss of mobility, depression, nursing home placement, and death. Patients with vertebral fractures may experience chronic pain, height loss, kyphosis, and decreased mobility... 

Evaluate patients for progression of osteoporosis, including signs and symptoms of new fragility fracture (e.g., localized pain), loss of height, and physical deformity (e.g., kyphosis). Patients should be assessed on an annual basis or more often if new symptoms present. 

The spinal cord emerges from the brain stem at the base of the skull and terminates at the second lumbar vertebra. The thoracic spine is most vulnerable to cord compression because of natural kyphosis and because the width of the thoracic spinal canal is the smallest among the vertebrae. Most spinal cord compression is due to adjacent vertebral metastases that compress the spinal cord or from pathologic compression fracture of the vertebra. This results in significant edema and inflammation in the affected area. 

Kyphosis Abnormal curvature of the spine resulting in protrusion of the upper back hunchback. 

Rat (Fischer- 344) 90 d 10.3 101 M (kyphosis decline in tail tip curl) MacEwen and Vernot 1983 Durad MP280... 

Rat (Sprague- Dawley) 4 hr Resp Musc/skel 880 (congested lungs, bloody nasal discharge, rapid and shallow breathing) 880 (kyphosis) Kinkead et al. 1987b (B85-174)... 

In animals, the only musculoskeletal effect observed was kyphosis, a deformity of the spine characterized by extensive flexion. Kyphosis was observed in rats exposed to 100 mg/m3 of Fyrquel 220 and 101 mg/m3 of Durad MP280 for an intermediate duration (MacEwen and Vemot 1983). The kyphosis was not observed at 10 mg/m3. It is not known whether the kyphosis was due to neurological or musculoskeletal... 

MP280 (continuous exposure for 90 days) produced kyphosis (a deformity of the spine characterized by extensive flexion) and a decrease in the tail tip curl reflex in rats and anorexia, lethargy, cachexia, and head droop in rabbits after exposure to 101 mg/m3 exposure to 10.3 mg/m3 produced no signs of neurotoxicity in these species (MacEwen and Vemot 1983). Hamsters similarly exposed to 101 mg/m3 Durad MP280 showed no evidence of neurotoxicity in this study. Aerosols of Fyrquel 220 (continuous exposure for 90 days) likewise produced kyphosis in rats at 100 mg/m3, but no clinical signs of neurotoxicity in rabbits or hamsters at 100 mg/m3 (MacEwen and Vemot 1983). Because of the uncertainty that the kyphosis observed in rats is a neurological or muscular effect, this effect has been discussed in both sections. 

In a series of acute lethality studies, lethargy and inactivity were noted in rats exposed for 4 hours to lethal concentrations of DTNSRDC N501 (6,430 mg/m3) (MacEwen and Vemot 1983). Kyphosis was observed in rats exposed to 880-5,030 mg/m3 of a polyalphaolefin hydraulic fluid designated as B85-174 (Kinkead et al. 1987b). Because of the uncertainty of whether the kyphosis is a neurological or muscular effect, this effect is discussed in both the Musculoskeletal Effects and Neurological Effects sections. No other information was located on neurological effects in animals after inhalation exposure to polyalphaolefin hydraulic fluids. 

Following a 90-day continuous exposure to 101 mg/m3 of Durad MP280, leukocytosis, kyphosis, and testicular atrophy were observed in rats and 100% mortality, cachexia, head droop, anorexia, and lethargy were observed in rabbits. No effects were observed in either species at 10.3 mg/m3 Durad MP280 (MacEwen and Vemot 1983). Continuous exposure to 100 mg/m3 of Fyrquel 220 for 90 days resulted in kyphosis in rats (MacEwen and Vemot 1983) the NOAEL for this effect was 10.1 mg/m3. No adverse effects were observed in rabbits exposed to 100 mg/m3 Fyrquel 220 continuously for 90 days (MacEwen and Vemot 1983). At the lowest tested concentration of Cellulube 220 (2,000 mg/m3, 4 hours/day,... 

Polyalphaolefin Hydraulic Fluids. There is limited information on the potential of polyalphaolefin hydraulic fluids to induce musculoskeletal effects. Kyphosis, a deformity of the spine characterized by extension flexion was observed in rats exposed to 880-5,030 mg/m3 (concentration eliciting response not reported) of a polyalphaolefin hydraulic fluid designated at B85-174 for 4 hours (Kinkead et al. 1987b). It is not known if this effect is related to damage to the musculoskeletal system or to neurological damage. This is the only study that examined musculoskeletal effects. Thus, the likelihood of musculoskeletal effects occurring in humans exposed to polyalphaolefin hydraulic fluids cannot be determined. 

The most common osteoporosis-related fractures involve the vertebrae, proximal femur, and distal radius (wrist or Colies fracture). Two-thirds of patients with vertebral fractures are asymptomatic the remainder present with moderate to severe back pain that radiates down a leg after a new vertebral fracture. The pain usually subsides significantly after 2 to 4 weeks, but residual, chronic, low-back pain may persist. Multiple vertebral fractures decrease height and sometimes curve the spine (kyphosis or lordosis) with or without significant back pain. 

A complete physical examination and laboratory analysis are needed to rule out secondary causes and to assess kyphosis and back pain. Laboratory testing may include complete blood count, liver function tests, creatinine, urea nitrogen, calcium, phosphorus, alkaline phosphatase, albumin, thyroid-stimulating hormone, free testosterone, 25-hydroxyvitamin D, and 24-hour urine concentrations of calcium and phosphorus. Urine or serum biomarkers (e.g., cross-linked N-telopeptides of type 1 collagen, osteocalcin) are sometimes used. 

Figure 2.6 Crooked calf syndrome with (a) arthrogryposis, and (b) cleft palate. Other skeletal malformations not shown here include scoliosis, torticollis, lordosis and kyphosis. 

Osteoporosis is defined as a generalized decrease in bone mass (osteopenia) that affects bone matrix and mineral content equally, giving rise to fractures of vertebral bodies with bone pain, kyphosis, and shortening of the torso. Fractures of the hip and the distal radius are also commoa The underlying process is a disequilibrium between bone formation by osteoblasts and bone resorption by osteoclasts. 

There was kyphosis of the thoracic spine from T7 to T9, with pathological fractures. An MRI scan showed massive epidural fat extending from T1 to T9. She recovered 3 months after surgical removal of the epidural fat. 

Shortened stature, kyphosis, or lordosis Vertebra, hip, or forearm fracture Laboratory tests 25(OH) vitamin D... 

Adult osteomalacia often has an insidious presentation. " " The underlying disorder may be more apparent than skeletal defects (e.g., diarrhea in sprue). Diffuse skeletal pain, bony tenderness, and proximal muscle weakness may occur. Pain on movement and muscle weakness may result in a characteristic waddling gait. Hypophosphatemia and secondary hyperparathyroidism may contribute to these symptoms. Tetany can result from sufficiently depressed serum ionized calcium. Skeletal deformities (infrequent in adults) include leg bowing, pigeon chest, scoliosis, kyphosis, and shortening of the spine. 

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