Take a moment to glance at yourself in the mirror from the side.
Do you notice if your head is aligned with your spine, or is it leaning forward, creating a noticeable curve in your upper back?
As we age, most of us experience a gradual loss in height, typically about half an inch per decade after the age of 30. By the time we reach our 70s, this height loss often becomes more apparent. (1)
However, if you're seeing more than just a subtle change — such as a forward-leaning head, a pronounced curve in your back, or a slouched posture — it might be a sign of vertebral fractures caused by bone loss.
So why do these posture changes happen? More importantly, what steps can you take to prevent them and ensure your bones stay strong and upright as you age.
The Vertebral Body
The vertebral column, or spinal column, is an important part of our skeletal system, supporting the head at the top and the pelvis at the bottom. (2)
The small bumps you feel along your back, from your neck to the sacrum, are the spinous processes of each vertebra.
On the front side of the vertebra lies the vertebral body, which has a soft, marshmallow-like shape. This area is vulnerable to compression fractures, especially as we age.
Between each vertebra are discs, which function as essential shock absorbers for the spine. (3)
When we're young, these discs are full of fluid and effectively cushion the vertebrae.
However, as we grow older, the discs gradually degenerate.
When the vertebral body weakens, the disc material can push into the bone, potentially causing discomfort, weakness, or even nerve damage. (4)
The vertebral body is also made up of two different types of bone. (5)
The outer layer consists of cortical bone, which is hard and dense. Inside, you’ll find trabecular, or spongy, bone, which is porous and flexible.
The trabecular bone acts as a dynamic shock absorber, allowing the vertebrae to be both lightweight and flexible. It helps distribute the forces exerted on the spine when we walk, run, or jump.
This intricate internal network functions best when those forces are absorbed evenly, which happens when we maintain proper posture and alignment.
However, poor posture disrupts this balance.
Over time, slouching or misalignment creates uneven pressure on the trabeculae, leading to tiny fractures.
These fractures accumulate, weakening the vertebral structure.
Eventually, activities like bending over to tie your shoes or opening a door fridge may cause the outer cortical bone to crack, resulting in compression of the vertebrae as the internal support weakens.
Vertebral Compression Fractures and Slouched Posture
A normal spine bends between 20 to 45 degrees in the upper region when viewed on an X-ray. (6)
If a spine bends 50 degrees or more, it could indicate vertebral or compression fractures due to bone loss. (7)
Again, these fractures occur when the vertebrae weaken and collapse.
The fracture typically affects the front portion of the vertebra, causing it to compress while the back remains intact.
As a result, the vertebra takes on a wedge-like shape, leading to a forward-leaning posture.
Similarly, as the intervertebral discs between the vertebrae lose hydration and shrink over time, the total length of the spine decreases, adding to the forward tilt. (8)
This compression of the spine is particularly common among older adults, especially those over 80, and is most pronounced in women after menopause, who commonly experience bone loss and fractures during this time.
In fact, about 25% of postmenopausal women experience vertebral compression fractures, and this condition becomes even more acute with age, affecting up to 40% of women aged 80 and above. (9)
With each fracture, the chances of further vertebral damage grow, worsening the stooped posture.
As this posture becomes more pronounced, the risk of future fractures increases, creating a vicious cycle of declining posture and rising fracture risks, as evidenced in one UCLA study. (10)
The study followed 596 women between the ages of 47 and 92, measuring their bone mineral density (BMD) in the hip and spine as well as the curvature of the spine.
To assess posture, researchers used small blocks under the head to see how many were needed for participants to lie flat without straining their necks.
Over the 4-year study, 18% of the women showed signs of stooped posture, requiring at least one block, and 107 reported new fractures.
The results were clear: women with posture problems were 1.7 times more likely to experience future fractures, regardless of their age, BMD, or any previous fractures.
But that's not all.
A hunched posture not only increases your risk of fractures but also makes you more prone to falls, especially if you're over 70.
This can result in serious injuries, such as a dislocated shoulder or spinal cord injury, which may limit your mobility and independence.
In a study published in Osteoporosis International, researchers worked with 1,220 participants for two years, monitoring weekly falls.
They found that 15% of participants had severe curvature of the spine, while 48% experienced at least one fall during the study. (11)
Interestingly, while the research didn’t show a direct link between spine curvature and fall frequency, participants aged 77 and older with hyperkyphosis had a higher fall risk, with a 1.67 times greater chance of falling.
Beyond just the risks of falls and fractures, a hunched back or stooped posture can change how you look, which can take a toll on your confidence and affect your everyday life.
Changes in posture can make clothes fit awkwardly, making you frustrated when nothing seems to fit right. Because of this, some people avoid social events altogether.
For many, a curved spine also brings ongoing pain.
As the spine bends more, it puts extra strain on the muscles, tendons, and nerves in your back. Over time, even simple tasks like walking, getting up from a chair, or driving can become challenging.
In severe cases, this curvature can press on internal organs, making breathing and digestion difficult. (12)
It can restrict your lung capacity, which makes it harder to catch your breath and can leave you feeling drained. You might even experience digestive issues like acid reflux or trouble swallowing.
What’s particularly worrying about vertebral compression fractures is how subtle they can be.
Often, these fractures fly under the radar because they don’t always come with severe pain or other noticeable symptoms.
In fact, more than two-thirds of people with a vertebral fracture don’t even realize they have one, often mistaking the discomfort for regular back pain or simply normal symptoms of aging. (13)
Eventually, these unnoticed fractures can worsen over time, leading to a more pronounced curvature in the spine.
What You Should Do
Taking proactive steps to prevent bone loss is important to support strong bones and reduce the risk of fractures, especially as we age.
First, you should be aware of your family history and any personal risk factors.
If you’re over 65 or have multiple risk factors, consider getting a bone density test, also known as a DEXA scan. (14)
The DEXA scan measures calcium and mineral levels in your bones, providing a T-score that compares your bone density to that of a healthy 30-year-old, helping you understand your bone health status.
- A T-score between -1 and +1 means your bone density is normal.
- A T-score between -1 and -2.5 indicates low bone mass.
- A T-score of -2.5 or lower signals weak bones and a higher risk of fractures.
Alongside regular screenings, living a healthy lifestyle can support your bone density.
If you smoke or drink heavily, try to cut back or quit.
Research shows that older smokers are up to 40% more likely to suffer fractures, especially in the hips, compared to non-smokers. (15)
Why? Smoking interferes with your body's ability to absorb calcium, an important nutrient for keeping bones strong and healthy. (16)
On top of that, nicotine slows down the production of osteoblasts, the cells responsible for building bone. It also disrupts estrogen levels, your body’s natural antioxidant that helps maintain bone strength and health, especially in women. (17)
Chronic alcohol use can also interfere with bone growth and remodeling, reducing bone density and increasing the risk of fractures. (18)
You can also try adding weight-bearing exercises like walking, stair climbing, or jogging to your daily routine.
When you're on your feet, your bones and muscles work against gravity, which helps strengthen them. The more your legs and feet support your body weight, the harder your bones work to stay strong. (19)
Similarly, strength training, whether through free weights, resistance bands, or bodyweight exercises, can strengthen not only your muscles and tendons but also your bones. (20)
It's especially effective for building back muscles, which helps maintain good posture and supports bone density at the same time.
If you're new to strength training or dealing with advanced bone loss, it's important to start with exercises that match your comfort level.
Your doctor or the Bone Coach Team can help you develop a safe and effective strength-training routine, and guide you on the proper forms and techniques to help you avoid injuries and get the most out of your workouts.
Most importantly, don’t forget about nutrition.
Eating a well-rounded diet rich in calcium and vitamin D is crucial for supporting overall health and strong bones. (21)
Great sources of calcium include cultured and fermented dairy, bone-in sardines or mackerel, arugula, cabbage, broccoli, brussels sprouts, sesame seeds, and dried figs.
While you can soak up vitamin D from sunlight, you can also find it in fatty fish like salmon, herring, and sardines, as well as in egg yolks and mushrooms (specifically D2).
In addition to vitamin D and calcium, you should also replenish collagen, the key nutrient that makes up the structure of our bones. (22)
Collagen makes up about 30 to 40% of bone mass, providing the structural framework for mineralization to occur. (23)
This protein not only supports healthy bone mineral density but also helps maintain the elasticity and integrity of spinal discs. (24)
One of the best sources of collagen is collagen peptides.
By helping to harden and strengthen bones, collagen peptides support healthy bone density, particularly in areas like the upper femur and lumbar spine, which are often the first to experience bone loss. (25)
In fact, a study published in Nutrients reported that postmenopausal women who were given specific, bioactive collagen peptides (SCP) saw noticeable improvements in bone density in both the spine and femoral neck after just 12 months. (26)
Researchers worked with 131 women to investigate how taking these specific collagen peptides could affect bone mineral density (BMD) in their spines and femoral necks over a year.
They also looked at some blood markers related to bone health.
Only 102 women completed the study, but the results were promising.
The participants who consumed the specific collagen peptides showed increases in BMD and T-scores for both the spine and femoral neck compared to the placebo group, which experienced declines in their T-scores.
Moreover, a marker for bone formation (P1NP) increased in the SCP group, whereas a marker for bone degradation (CTX) rose in the placebo group.
This shows that specific collagen peptides can support bone health and strength as we age.
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