Do we lose height as we age?

A straight answer to this question is “Yes”. Diving deep into this, we need to understand the concepts of physiological aging and pathological loss of height due to osteoporosis and fractures.

Standard age related loss of height is usually linked to gradual desiccation and degeneration of the discs between our vertebra of the spinal column. As we age, there is a net bone loss due to imbalance between bone formation and resorption. In physiological aging, the rate of loss is slow, around 1 cm every decade after the age of 40. The overall spinal alignment is not altered and usually remains asymptomatic. However, the changes in the microarchitecture of the vertebra leads to repetitive strain on regular loads like bending forwards, lifting a bag, running etc leading to micro fractures. When such loads exceed the compromised load bearing capacity, vertebral compression fractures occur which can lead to rapid loss of height over few years.

A ‘silent thief’ as we age is Osteoporosis, the thinning of bone tissue causing weakness of the vertebra. One of the major causes of persistent back pain and disability in the elderly are vertebral compression fractures which happen secondary to fragility of the bones. Across the world, evidence suggests that one in three women and one in five men over the age of 50 suffer from an osteoporotic fracture. Prior vertebral fractures can increase the risk of further fractures by five-fold and cause a ‘fracture cascade’. These fractures can be of different types, most common being wedge compression while others like biconcave fractures and crush fractures can happen.

These fractures can happen silently without a fall and sometimes without symptoms of pain and progress slowly over years. Compression fractures at multiple levels of the spine can happen as you age and vertebrae crumple upon under the weight of everyday activities which can lead to loss of height. As the fractures happen, the global spinal alignment shifts forwards called as kyphosis and a prominent hump over the middle of the back called ‘dowager’s hump can be noticed. The structural bending can dramatically reduce our height with the distance between skull to pelvis reducing sometimes upto 6 inches.

To prevent this cascade, we need to follow certain lifestyle modifications from young age. Boosting our daily intake of calcium to strengthen the bones with

adequate hydration, improving our core muscle strength of the back, regular exercises, avoiding prolonged sitting and maintaining ergonomics at workplace, avoiding smoking and preventing falls are of utmost importance. Regular assessment of bone density after the age of 50 and medications to prevent loss of bone density along with weight bearing exercises can avoid fractures.

Osteoporotic vertebral compression fractures are usually managed conservatively with rest and medications. However, certain fractures require bone cementing procedures like vertebroplasty and kyphoplasty to help restore the vertebral height, reduce pain and prevent progression to kyphotic cascade. Neglected cases of vertebral fractures with established kyphosis may need deformity correction surgery with instrumentation to prevent progression of deformity and improve the quality of life.