Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: Osteoporosis and hyperkyphosis could impose a considerable financial and therapeutic burden on the affected society. Thus, new strategies to prevent or manage such complications are of significant importance. Here we evaluate the effect of ‘Dynamic Hyperextension Brace’ (DHB) on bone density, and hyperkyphosis correction.
Methods:Sixty postmenopausal women were randomly assigned to the case and control groups and followed for one year. DHB was applied in the case group according to the pre-designed protocol and the patients’ clinical and paraclinical parameters, including bone mineral density (BMD), kyphosis angle, osteoporotic fracture, and serum alkaline phosphatase (ALP) were evaluated in two groups.
Results:Despite no significant difference in basic BMD and kyphosis between the case and control groups, BMD and kyphosis were significantly improved in the DHB treated group, at the end of the study (P=0.003 and P=0.001, respectively). Serum ALP level was significantly higher in cases compared to the controls (P=0.48). The vertebral fracture rate was also lower in the case group compared to the controls.
The efficacy of bracing in osteoporosis and kyphosis management should be more emphasized. However, more detailed and controlled studies with more patients and a longer follow-up period is needed to adequately evaluate the long-term results of braces, including DHB.


Main Subjects

1. Nevitt CS, ODowd KJ. Epidemiology of osteoporosis
and osteoporotic fractures. Epidemiol Rev. 1985;
2. Kanis JA. Diagnosis of osteoporosis and assessment of
fracture risk. Lancet. 2002; 359(9321):1929-36.
3. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE.
Age-related hyperkyphosis: its causes, consequences,
and management. J Orthop Sports Phys Ther. 2010;
4. Papadakis M, Aggeliki L, Papadopoulos EC, Girardi
FP. Common surgical complications in degenerative
spinal surgery. World J Orthop. 2013; 4(2):62-6.
5. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson
DG, Vaccaro AR, et al. Complications in spine surgery. J
Neurosurg Spine. 2010; 13(2):144-57.
6. Järvinen TL, Sievänen H, Khan KM, Heinonen A,
Kannus P. Shifting the focus in fracture prevention from
osteoporosis to falls. BMJ. 2008; 336(7636):124-6.
7. Gass M, Dawson-Hughes B. Preventing osteoporosisrelated
fractures: an overview. Am J Med. 2006;
8. Wilkins CH, Birge SJ. Prevention of osteoporotic fractures
in the elderly. Am J Med. 2005; 118(11):1190-5.
9. Cortet B. Osteoporosis: from early fracture prevention
to better bone health with strontium ranelate.
Rheumatology. 2009; 48(Suppl 4):iv14-9.
10. Pisani P, Renna MD, Conversano F, Casciaro E, Di
Paola M, Quarta E, et al. Major osteoporotic fragility
fractures: risk factor updates and societal impact.
World J Orthop. 2016; 7(3):171-81.
11. Wong CC, McGirt MJ. Vertebral compression fractures:
a review of current management and multimodal
therapy. J Multidiscip Healthc. 2013; 6(1):205-14.
12. Pfeifer M, Begerow B, Minne HW. Effects of a new
spinal orthosis on posture, trunk strength, and quality
of life in women with postmenopausal osteoporosis:
a randomized trial. Am J Phys Med Rehabil. 2004;
13. Sinaki M. Exercise for patients with osteoporosis:
management of vertebral compression fractures and
trunk strengthening for fall prevention. PM R. 2012;
14. Chen JH, Liu C, You L, Simmons CA. Boning up on Wolff’s
Law: mechanical regulation of the cells that make and
maintain bone. J Biomech. 2010; 43(1):108-18.
15. Karol LA, Virostek D, Felton K, Wheeler L. Effect of 

compliance counseling on brace use and success in
patients with adolescent idiopathic scoliosis. J Bone
Joint Surg Am. 2016; 98(1):9-14.

16. DiRaimondo CV, Green NE. Brace-wear compliance in
patients with adolescent idiopathic scoliosis. J Pediatr
Orthop. 1988; 8(2):143-6.
17. Reinker KA. Compliance counseling improves
outcomes of bracing for patients with idiopathic
scoliosis. Commentary on an article by Lori A. Karol,
MD, et al.: “Effect of Compliance Counseling on Brace
Use and Success in Patients with Adolescent Idiopathic
Scoliosis”. J Bone Joint Surg Am. 2016; 98(1):e4.
18. Longo UG, Loppini M, Denaro L, Maffulli N, Denaro
V. Conservative management of patients with an
osteoporotic vertebral fracture A review of the
literature. J Bone Joint Surg Br. 2012; 94(2):152-7.
19. Matussek J, Boluki D, Füssel S, Grifka J. Orthotic
methods for osteoporosis and osteoporotic vertebral
fracture. Orthopade. 2010; 39(4):387-96.
20. Whyte MP. Hypophosphatasia and the role of alkaline
phosphatase in skeletal mineralization. Endocr Rev.
1994; 15(4):439-61.
21. Francis RM, Baillie SP, Chuck AJ, Crook PR, Dunn N,
Fordham JN, et al. Acute and long-term management
of patients with vertebral fractures. QJM. 2004;