Harvard Women's Health Watch

How to preserve your posture

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You don't have to develop the stoop and "dowager's hump" that were once thought to be inevitable consequences of aging.

If you're over 50, the odds that you'll experience a major fracture because of osteoporosis are one in two. Although osteoporosis increases the risk of fractures in every bone of the body, the spinal bones (vertebrae) are particularly vulnerable. For women with osteoporosis, as little as a cough or a sudden movement can cause a compression fracture, creating pain and potential deformity.

Preventing vertebral fractures

Strong bones are the best insurance against fractures. While it's true that all people lose bone as they age, osteoporosis is not inevitable; there are still many things you can do to hold on to the bone you have and perhaps even replace some lost bone.

Do weight-bearing exercise. "Resistance exercise can help maintain bone mass, which in turn may help prevent osteoporosis and osteoporosis-related compression fractures that can lead to the 'dowager's hump," says Dr. Christopher Bono, chief of the orthopedic spine service at Harvard-affiliated Brigham and Women's Hospital. Any exercise that involves working against gravity, such as running, walking, weight lifting, or stair climbing, can potentially build bone. Exercise also increases muscle mass, which can help protect bones from injury, and it improves strength, agility, and flexibility, thus decreasing susceptibility to falls.

Eat a balanced diet. Aim for a total calcium intake of 1,200 milligrams daily, mostly through foods. If you don't supply your body with the calcium it needs, it will respond by raiding calcium stores in your bones. In addition, the National Osteoporosis Foundation recommends 800 to 1,000 international units of vitamin D per day for bone health.

Avoid excess alcohol. Too much alcohol interferes with calcium balance and alters bone-building hormones, including estrogen and cortisol. Try to limit daily consumption to one drink of wine, beer, or spirits.

If you still smoke, quit. Tobacco use has been linked to lower bone density, and it's clear that smoking increases fracture risk.

Get a bone density test. "All women who are postmenopausal should be evaluated for osteoporosis using a bone mineral density test," says Dr. Bono. In addition, there are risk calculators available on the Internet that use your bone density and the presence of other risk factors to determine fracture risk. Once you have the results of your test, you and your doctor can discuss what measures—including bone-building medications—you can take to reduce your risk.

Treating vertebral fracture

Compression fractures may occur gradually and relatively painlessly, but they can also be quite painful. Pain that results from vertebral compression fractures can usually be treated with short-term acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve), opioids, or calcitonin.

Surgery is a last resort to alleviate the pain. Two minimally invasive procedures—vertebroplasty and kyphoplasty—involve using MRI to guide the injection of bone cement to strengthen compressed vertebrae. (In kyphoplasty a balloon is inflated to expand the vertebra before the cement is injected.) Some studies suggest that these procedures may reduce pain in the short run, but randomized controlled clinical trials have not found firm evidence of long-term benefit. And they carry a risk of certain side effects, including nerve damage and leakage of cement into surrounding tissues. Therefore, these procedures are recommended only for people whose pain is so severe that it requires hospitalization and for those with fracture-related pain that has not improved over a six-week period following the fracture.

If you're considering surgery, make sure your doctor discusses all the potential outcomes of kyphoplasty and vertebroplasty, including the risks and possible complications as well as the potential benefits, Dr. Bono advises.

What vertebral fractures can do to your spine


A compression fracture doesn't crack a vertebra in two; it causes it to collapse (1). As additional compression fractures occur, the collapsed vertebrae form a downward curve in the spine—a condition called dorsal kyphosis (2), or "dowager's hump."

As the spine curves outward, the length of the torso shrinks. With less space to accommodate them, the abdominal organs are pushed forward. This can lead to a host of discomforts, including breathing difficulties, digestive disorders, constipation, and urinary incontinence.

The changes in the distribution of your body weight alter your center of gravity and can throw off your balance, making it more difficult to get around and increasing the risk of falls and more fractures.