Q. What causes a dowager's hump? I've had a hump in my back below my neck for a few years now but certainly don't consider myself old. I haven't even gone through menopause yet. Could this just be some fatty tissue from being overweight? How can I get rid of it?

A. Although the term "dowager's hump" isn't a medical one, I take it you're referring to the hunched-over appearance of some elderly people. The term probably gets its name from its association with elderly women who show the effects of osteoporosis.

Among other effects, this bone-thinning disorder can collapse backbones. If enough backbones collapse, the spine actually shortens and may buckle. These changes explain why some people grow shorter as they get older. Osteoporosis and scrunched backbones also explain the outward curvature of the upper spine, commonly known as a dowager's hump.

Besides osteoporosis and a curved spine, a few other things can resemble a dowager's hump. One is a growth of fatty tissue called a lipoma. Lipomas are benign tumors of fat that can develop almost anywhere in or on the body.

A large lipoma at the base of the neck could resemble a dowager's hump. If that is the case with you, you could have it removed by surgery. But most of the time a lipoma is just a cosmetic problem and needn't be cut out unless it really bothers you.

Another cause of a hump on the back is a rare condition known as Cushing's syndrome. This disorder results when the body makes too many hormones known as corticosteroids. More often, it results from long-term use of corticosteroid medicines like prednisone. Long-term steroids are used to treat disorders such as lupus, sarcoidosis or serious kidney diseases.

These hormones make fatty tissue grow in certain parts of the body. They may lead to a puffy, rounded face and the characteristic hump of fatty tissue at the base of the neck. The not-so-flattering term doctors use for this growth is a "buffalo hump."

It's unlikely you'd have a hump from Cushing's syndrome without any of the other problems it causes, such as rounded face, weakness, marked weight gain, absence of menstrual periods, excessive growth of hair on the face, arms and other parts of the body and high blood pressure. Once diagnosed, Cushing's syndrome responds to treatment with drugs or surgery.

A few uncommon diseases of the spine can cause curvature of the upper backbone. These include infections of the backbone by tuberculosis, an inflammation known as spondylitis or a bone disorder known as Paget's disease.

A simple X-ray of the back should point to a problem with the backbones themselves. If the X-ray doesn't show anything, you probably don't have a serious bone disorder and may just have some extra fatty tissue on your back from being overweight.

Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.

Consultation is a health education column and is not a substitute for medical advice from your physician.

Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.