DEAR DR. ROACH: My mom had a compression fracture to her L2 vertebrae due to osteoporosis. Her head leans forward constantly. It has created difficulty for her when looking forward while walking and sleeping. Do you have anything that you can suggest for her to do? — J.F.

ANSWER: Compression fractures of the neck, chest and lower spine are more common than hip fractures. They can cause loss of function, chronic pain, depression, and loss of independence. For all these reasons, prevention is critically important, and nobody is at a higher risk than a person who has already had a fracture. So, the first thing I suggest is making sure that your mom is getting proper treatment to reduce her risk of another fracture.

Kyphosis, sometimes called a “dowager hump,” is a frequent complication of vertebral fractures, which usually results in multiple fractures. In addition to neck problems, the loss of height in the thoracic and lumbar vertebra can compress abdominal contents, leading to clothes not fitting, a protuberant abdomen, and feeling full with less food.

Braces are occasionally recommended for kyphosis, but I do not recommend them for this. Braces don’t really improve the underlying changes in the spine and can make core muscles weaker.

Surgery, such as vertebroplasty and kyphoplasty, is an option for some people. The most common indication for these procedures is pain that isn’t being sufficiently treated by medication or other treatments. I only consider a surgical referral if a person’s quality of life is severely affected by their back condition, which may be the case with your mom.

Exercise and physical therapy may provide a great benefit to her symptoms, as well as further fracture prevention.

DEAR DR. ROACH: I am a 23-year-old man who has been having sleep issues for years. It started in middle school. Since then, I often have trouble going to sleep, and sometimes I wake up around 3-4 a.m. and cannot go back to sleep for hours. Then I’m tired during the day and miss out on social opportunities or other things.

I’ve tried good sleep hygiene and a calming bedtime routine that includes no phone use, and I’ve asked my doctor about this issue. Basic blood work shows nothing out of the ordinary. How should I proceed? Should I have my hormone levels tested? — S.H.

ANSWER: I recommend a sleep medicine specialist. Your problem started quite early, and although you have made some very reasonable changes, they don’t seem to be helping.

High thyroid levels can cause sleep disturbances and should be tested, but it’s pretty unlikely for a person to have sleep disturbances without the many other symptoms of high thyroid levels.

Medications are common causes of sleep troubles, but you don’t mention any. A sleep specialist can perform a thorough evaluation for any underlying medical, neurological and psychiatric conditions that might be affecting your sleep.

If a clear disorder isn’t found, you might be recommended cognitive behavioral therapy for insomnia, which avoids the numerous side effects of medications. It can provide you with skills that you can use for your lifetime, which are as effective as medication.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved