Using three decades of global health data, researchers found that weight gain and metabolic health, not just aging, are driving a sharp rise in back pain among postmenopausal women, highlighting the need for targeted prevention worldwide.
Study: Global, regional, and national burden of low back pain in postmenopausal women from 1990 to 2021: a comprehensive analysis using data from the Global Burden of Disease Study 2021. Image credit: amenic181/Shutterstock.com
In a recent study published in Frontiers in Endocrinology, researchers conducted a comprehensive analysis to quantify the burden of low back pain (LBP) in postmenopausal women. The study analyzed three decades of data from the Global Burden of Disease (GBD) Study 2021 and found that the absolute number of LBP cases in women over 55 nearly doubled from 1990 to 2021.
The study further identified high body mass index (BMI) as a leading modifiable risk factor (~14.2%), contributing more to LBP-related disability than occupational exposures and smoking. These findings reveal postmenopausal women as a high-risk population for LBP-related disability and disease burden, highlighting the need for enhanced monitoring and clinical interventions to promote healthy aging in this globally growing cohort.
Background
LBP is a leading cause of disability and a major contributor to healthcare costs worldwide. Advances in modern medicine have extended life expectancy, resulting in a larger elderly population than ever before.
Recent evidence suggests that postmenopausal women are at particularly high LBP risk, attributed to a sharp decline in estrogen, which has been observed to accelerate major LBP contributors like osteoporosis and intervertebral disc degeneration. These vulnerabilities are now known to be further compounded by other risk factors such as central obesity, loss of muscle mass (sarcopenia), sleep disturbances, and psychological factors.
Surprisingly, however, LBP’s general drivers remain poorly understood. Unravelling the true LBP burden in vulnerable subpopulations (e.g., postmenopausal women) necessitates a detailed, large-scale analysis of these subpopulations. The future development of effective, targeted health- and aging-promoting interventions requires a concise understanding of the specific trends, regional variations, and key risk factors in these high-risk demographics.
About the study
The present study addresses these knowledge gaps and helps inform future public health interventions by comprehensively analyzing low back pain in postmenopausal women (“women aged 55 and older”). The study uses long-term data from the Global Burden of Disease (GBD) Study 2021, which provides standardized epidemiological estimates for hundreds of diseases across 204 countries and territories from 1990 to 2021.
Study data of interest included incidence (new cases), prevalence (total cases), and disability-adjusted life years (DALYs; measure of overall disease burden) for LBPs in the postmenopausal context. The analysis incorporated sociodemographic and regional data modelled by the GBD framework, rather than individual participant records.
Statistical analyses involved the computation of temporal trends using age-standardized rates (thereby accounting for changes in population structure over time). The study focused on the contributions of three specific major modifiable risk factors: 1. high body-mass index (BMI), 2. smoking, and 3. occupational or environmental exposures, stratifying the results by the Sociodemographic Index (SDI) of different regions.
Study findings
The present study establishes and verifies the association between LBP incidence and postmenopause, revealing a dramatic increase in the disease’s absolute burden during the past three decades. Specifically, from 1990 to 2021, the annual number of incident cases nearly doubled from 35.2 million to 70.3 million, and the total number of prevalent cases rose from 89.9 million to 176.8 million.
LBP-associated disability (DALYs) also doubled, from 9.8 million to 19.1 million years, highlighting the need for interventions to reduce LBP incidence and outcomes.
Notably, despite these excessive absolute figures, age-standardized rates only demonstrated a modest decline, indicating that once population aging is accounted for, the risk for an individual woman has slightly decreased.
However, the study identified that significant gender disparity persists between older men and women, findings that in 2021, the burden of LBP in postmenopausal women was substantially higher than in age-matched men, with 1.78 times more new cases and 1.86 times more prevalent cases recorded.
Risk factor analysis revealed that high BMI is the leading modifiable driver of LBP-related disability globally, accounting for 14.2% of all DALYs, followed by occupational and environmental exposures (12.6%) and smoking (7.3%).
However, risk factors demonstrated differential geographic importance, with high BMI representing the dominant driver of LBP outcomes in high-income countries. At the same time, occupational exposures were the primary factor in middle- and low-income regions.
Conclusions
The present study verifies that LBP’s global burden is higher than expected and continues growing, even as age-standardized rates have modestly declined due to demographic aging.
Study findings underscore the urgent need for targeted interventions that address the key modifiable risk factors. In wealthier and developed nations, strategies must prioritize weight management and metabolic health. In developing regions undergoing industrialization, the focus should be on improving workplace ergonomics and occupational safety.
Smoking cessation remains a modifiable risk factor that could improve LBP outcomes (in postmenopausal women) irrespective of geographic location. Healthcare systems may leverage these findings to tailor their interventions better, potentially improving future outcomes in this vulnerable population.
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