HEIGHT AND HEIGHT

LOSS IN CLINICAL
PRACTICE
KERRY SIMINOSKI
University of Alberta
VERTEBRAL FRACTURES LEAD TO HEIGHT LOSS
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ME
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OBJECTIVES

NONE
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Humans are exquisitely sensitive
to the height of other humans
Average male: 5’ 9”

Tall male: 5’11” Short male: 5’ 7”

Difference from average: 2” = 2.9%

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If we were as sensitive for other
physical parameters, we could detect:

• 1” (2.5 cm) for waist size (for 34” waist)

• 2.0 kg (4.4 lb) for weight (for 70 kg)

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How are we so sensitive to height?

• Bipedal stance

• Eyes near top of head

• Binocular vision
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The Role of Height in Modern Life

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What role does height play in modern life?

• models are taller than average

 Models are taller than average

• female runway model 5’ 9”

• average female 5’ 4”

• male runway model 6’ 1”

• average male 5’ 9”
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What role does height play in modern life?

• models are taller than average

• athletes are taller
Athletes are taller than average

NHL
Wayne Gretzky?

Connor McDavid?
Athletes are taller than average

Baseball
Athletes are taller than average
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What role does height play in modern life?

• models are taller than average

• athletes are taller
• politicians are taller
 Politicians are taller

Average American President height

since 1900 = 6’0”
American Presidential Elections Since 1900

Green indicates
taller candidate won

20/29 = 69%

p < 0.05
 Politicians are taller

Trump 6’ 2” vs. Rubio 5’10”

Kasich 5’ 9”
Cruz 5’11”
 Politicians are taller

Sanders 6’ 0” vs. Clinton 5’ 6.5”

+2.9% +3.9%
 Politicians are taller

Trump 6’ 2” vs. Clinton 5’ 6.5”

+5.7% +3.9%

Cruz 5’11”
+2.9%
 Politicians are taller
What about Canadian politicians?

J. Trudeau 6’2” Harper 6’1”

Chretien 6’1” Martin 6’1”

Pearson 6’1”
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What role does height play in modern life?

• models are taller than average

• athletes are taller
• politicians are taller
• taller people earn more money
 Taller people earn more money

$800 $US/year per inch of height for men

 For 6’ 0” vs. 5’ 5” this is $5,525 per year

 $220,000 over career

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There is a perceived value in being taller

People want to be taller

How do they try to do this?

Lots of ways!!
Methods to Increase Height
• exercise
Exercise
 Exercise

Vertebrae can’t grow

Disks can de-compress

 Exercise

Note detail
Exercise
Exercise
Exercise
Exercise
Methods to Increase Height
• exercise
• mechanical
Mechanical Methods
Mechanical Methods
Methods to Increase Height
• exercise
• mechanical
• electrical
 Electrical Methods

Growth plate fused in adults

Methods to Increase Height
• exercise
• mechanical
• electrical
• drugs
 Drug Methods

Growth Hormone causes growth

GH treatment works in children

• with GH deficiency
• without GH deficiency (e.g. Down’s)
 Drug Methods
GH doesn’t work after growth plates close
In adults it causes bone thickening
 Drug Methods

Internet suggests GH in adults for height

• GH
• GH releasers (e.g. arginine)
• vitamins/herbs
• many others
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Vitamin/herb Testimonial
“I have been using B-Growth for 3 months
and gained 3 inches. You guys are great!”

Same site dismisses “...surgery, HGH,

dangerous Drugs, or other gimmicks.”
Methods to Increase Height
• exercise
• mechanical
• electrical
• drugs
• acupuncture
 Acupuncture
Acupressure
Includes chakra crystals

Bonus: “a good personality”

Methods to Increase Height
• exercise
• mechanical
• electrical
• drugs
• acupuncture
• surgery
Surgery
 Surgery

Bone broken and gradually pulled apart

Surgery
Methods to Increase Height
• exercise
• mechanical
• electrical
• drugs
• acupuncture
• surgery
• etc., etc., etc.
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The History of Height Measurement

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PREHISTORY: No Information

EARLY HISTORIC TIMES:

• “Heroes” were physically bigger
e.g. Ulysses, Sampson, Hercules
e.g. Iliad: Ajax the Greater, Ajax the Lesser
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RENAISSANCE

• Interest in height began

• Human dimensions analyzed

• Main goal: to understand relationships

of body parts for art
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1521

Vitruvius
(copied by Da Vinci)
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What Was The Motivation?

• Classical art (Greek and Roman)

had achieved good body representation

• This was lost in the middle ages

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Greek
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Roman
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Medieval
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Medieval
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What Did Artists Do?

• They proposed many ways to measure

and analyze the human form

• BUT: They studied Classical sculptures,

not live people
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1450
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1557

Durer
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RENAISSANCE
• After artists started measuring,
physicians began to take an interest

• Reason: to evaluate body shapes

associated with disturbances of
the four humours
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Renaissance scientists developed an

accurate measuring technique

• vertical mounted height scale

• right-angle sliding plate for top of head

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1672
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17th CENTURY
• the first systematic height measurements

• began for military purposes by

Frederick the Great

1. Best physical specimens

2. Marching
3. Catching deserters
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Johann Wolfgang von Goethe

1779

Goethe measuring height

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18th CENTURY
• Public Health was developing

• Height was recognized as a useful

health parameter in children and adults
• Upper class taller as children and adults
• Height at a given age lower with famine
• Studies on limited groups only
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Royal Navy recruit heights

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19th CENTURY

• Public health initiatives began to gather

population data

• Initially Europe, then USA

• Emphasis on children
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20th CENTURY
• Harpenden study in England
• started in WWII to monitor health status
of children using kids in an orphanage
• continued after to provide normal
growth curves
• Tanner and Whitehouse
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Harpenden Stadiometer
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20th Century

• Second half of 20th Century

• Use of childhood growth curves

• Wide-scale adult height data

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Status of Height in Modern Times

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What is the Trend in Adult Height?

• gradual increase in peak adult height

until 1970s (or 1950s in N. America)
• no increase over last three-five decades

Average male: 5’ 9” Average female: 5’ 4”

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Normal Pattern of Adult Height

• reaches peak age 16-18

• stable to age 50
• decreases 3 cm from 50 to 80
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What Determines Peak Height?

• Genetics
• Environment
 Genetics and Height

1 SD = 2.5”

Effect of one gene

Environment and Height

Malnutrition

Royal Navy recruit heights

Environment and Height

Baseball

Malnutrition
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How Is Height Measured?

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How Should We Measure Height?

• BEST: unit with fixed horizontal arm

• PROBABLY OK: office weight scale with

carpenter’s level
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Stadiometer
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How Do We Make
Height Measurement Reproducible?
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Why Do We Measure Height As Part

of Medical Assessment?
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Use of Height in Medicine

• monitor growth in children

• calculate BMI
• monitor height loss in adults to detect
vertebral fractures
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Childhood Growth

Important parameter of development

• Detects disease
• Monitors disease
• Monitors therapy
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Falling off curve

Rx started
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Monitoring Body Mass Index

• Used as marker of relative weight

• Adjusts for body size [wt/(ht x ht)]

• Better correlation with measures of

fatness than simple weight or wt/ht
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WHO BMI CATEGORIES

Underweight <18.5
Normal 18.5-25
Overweight 25-30
Obese >30
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NEW WHO BMI CATEGORIES

Obesity I 30-35
Obesity II 35-40
Obesity III >40
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Monitor Height Loss in Adults to Detect

Vertebral Fractures

• Historical Height Loss

• Prospective Height Loss

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Vertebrae fracture

Disks shrink with age

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Height loss occurs with:

• vertebral fractures
• aging (3 cm by age 80) - due to disk
shrinkage
• other spinal and leg conditions

• I.E. there are causes of false positives

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1 cm is:

• the average height lost per vertebral

fracture
• the long term 95% CI for height
measurement

I.E. there are causes of false negatives

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Monitor Height Loss in Adults to Detect

Vertebral Fractures

• Historical Height Loss

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HISTORICAL HEIGHT LOSS

HISTORICAL HEIGHT LOSS =

Patient’s Tallest Recalled Height

– Measured Height
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HISTORICAL HEIGHT LOSS

Use Historical Height Loss (HHL) to

assess vertebral fracture probability
(women)
• HL > 6 cm OR = 14
• HL 1.6 - 5.9 cm OR = 2
• HL < 1.5 cm OR = 1
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HEIGHT LOSS

Use Historical Height Loss (HHL) to

assess vertebral fracture probability
(men)
• HL > 6 cm OR = 7
• HL 1.6 - 5.9 cm OR = 3
• HL < 1.5 cm OR = 1
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HEIGHT LOSS

Use Historical Height Loss (HHL) to assess

vertebral fracture probability

HHL > 6 cm = possible vertebral fracture

HEIGHT AND HEIGHT LOSS

Monitor Height Loss in Adults to Detect

Vertebral Fractures

• Historical Height Loss

• Prospective Height Loss

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HISTORICAL HEIGHT LOSS

PROSPECTIVE HEIGHT LOSS =

Measured Height 2 – Measured Height 1

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Use Prospective Height Loss (PHL) to assess
vertebral fracture probability
HT LOSS (cm) OR
women
0 1
0-1 2
1-2 5
2-3 13
3-4 23
>4 25
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Use Prospective Height Loss (PHL) to assess
vertebral fracture probability

• PHL > 2 cm = possible vertebral fracture

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OR of 1+ Incident Fracture

30
20 Odds Ratio
10 (OR)
0
>2 >3 >4
>1
<0 >0
Height Loss (cm)
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OR of 2+ Incident Fractures

60
40 Odds Ratio
20 (OR)

>1 >2 >3 >4

<0 >0
Height Loss (cm)
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OR of 3+ Incident Fractures
150
<0
100 Odds
Ratio >0
50 (OR) >1
0 >2

>3 >4 >3

>1 >2
<0 >0 >4
Height Loss (cm)
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120

100
OR
80

60
40
20
0
3 >3 >4
Fract 2
1 <0 >0
>1 >2
Height Loss
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An Application of Height Loss

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71 Year-old woman with diabetes

Height: 150 cm (5’1/2”)

Weight: 65 kg (143 lb)
BMI: 28.9

Target BMI: 25
Advised weight loss: 8.5 kg (18.7 lb)
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Tallest height = 162 cm

Measured height = 150 cm

Historical height loss = 12 cm

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Spine x-rays show 10 fractures

Height loss from fracture = 10 cm

Height loss from age = 2 cm

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Corrected Height = 160 cm

Corrected BMI = 25.4
Target BMI: = 25

Advised weight loss: = 1 kg (2.2 lb)

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OBJECTIVES
1. To think about height

2. Learn to measure height more accurately

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OBJECTIVES
3. To be reminded how height is used
in medical practice:
• Monitor childhood health
• BMI
• Detect vertebral fractures
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OBJECTIVES
4. Be aware of the amount of height loss
that indicates a possible vertebral fracture:

HHL: > 6 cm

PHL: > 2 cm
IDENTIFY VERTEBRAL FRACTURES AT AN
EARLY STAGE AND TREAT TO PREVENT
PROGRESSION