{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:19:42Z","timestamp":1783981182816,"version":"3.55.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T00:00:00Z","timestamp":1730332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Older women are at increased risk of spinal misalignment and its associated complications. This study investigated the influence of age, grip strength, and various sagittal spinal parameters on spinal alignment. The results indicate the need for comprehensive management strategies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional study included 200 older women who underwent bone health evaluations at the orthopedic department of a hospital. The study participants underwent dual-energy X-ray absorptiometry, grip strength measurement, and full-length spine radiography. Clinical and radiographic parameters were analyzed through Pearson correlation and linear regression analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Significant correlations were identified between grip strength and spinal parameters such as C7 slope and global tilt, indicating that muscle strength affects spinal alignment. Advanced age was associated with changes in sagittal spinal parameters, indicating that changes occur in body compensation over time. Furthermore, pelvic parameters such as pelvic tilt and sacral slope were significantly correlated with spinal curvature, indicating their critical roles in maintaining spinal stability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study revealed the critical roles of muscle strength and pelvic alignment in the management of spinal health in older women with low bone mass. Targeted interventions for increasing muscle strength, correcting posture, and achieving hormonal balance can notably improve spinal stability and reduce the risk of associated complications. Longitudinal studies should be conducted to validate and refine the intervention strategies and to extend the study findings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0312082","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T17:27:43Z","timestamp":1730395663000},"page":"e0312082","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Interrelationships of cervical spine sagittal alignment and whole spinopelvic alignment under implications of musculoskeletal health among independent elderly women in Taiwan: A cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"given":"Tzai-Chiu","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Tien","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru-Ping","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ing-Ho","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-8064","authenticated-orcid":true,"given":"Jen-Hung","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Hui","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6154-2167","authenticated-orcid":true,"given":"Kuang-Ting","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,31]]},"reference":[{"issue":"6","key":"pone.0312082.ref001","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1007\/s00198-022-06657-8","article-title":"Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review.","volume":"34","author":"M Chandran","year":"2023","journal-title":"Osteoporos Int."},{"issue":"5","key":"pone.0312082.ref002","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.bj.2018.08.001","article-title":"Secular trends in incidence of osteoporosis in Taiwan: A nationwide population-based study.","volume":"41","author":"FP Chen","year":"2018","journal-title":"Biomed J"},{"key":"pone.0312082.ref003","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/jehp.jehp_945_20","article-title":"Prevalence of primary osteoporosis and low bone mass in postmenopausal women and related risk factors","volume":"10","author":"E Hemmati","year":"2021","journal-title":"J Educ Health Promot"},{"issue":"10","key":"pone.0312082.ref004","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00198-021-05900-y","article-title":"The clinician\u2019s guide to prevention and treatment of osteoporosis.","volume":"33","author":"MS LeBoff","year":"2022","journal-title":"Osteoporos Int"},{"key":"pone.0312082.ref005","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7150\/jbm.23390","article-title":"Muscle and Bone Mass Loss in the Elderly Population: Advances in diagnosis and treatment","volume":"3","author":"CJ Padilla Col\u00f3n","year":"2018","journal-title":"J Biomed (Syd)."},{"issue":"5","key":"pone.0312082.ref006","doi-asserted-by":"crossref","first-page":"493","DOI":"10.3390\/bioengineering11050493","article-title":"Research of Global Tilt and Functional Independence: Insights into Spinal Health of Older Women.","volume":"11","author":"YC Chiu","year":"2024","journal-title":"Bioengineering (Basel)."},{"key":"pone.0312082.ref007","doi-asserted-by":"crossref","first-page":"1010102","DOI":"10.3389\/fendo.2022.1010102","article-title":"Screening of osteoporosis and sarcopenia in individuals aged 50 years and older at different altitudes in Yunnan province: Protocol of a longitudinal cohort study.","volume":"13","author":"X Liu","year":"2022","journal-title":"Front Endocrinol (Lausanne)."},{"issue":"1","key":"pone.0312082.ref008","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1515\/med-2021-0219","article-title":"Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain","volume":"16","author":"HJ Lee","year":"2021","journal-title":"Open Med (Wars)."},{"issue":"10","key":"pone.0312082.ref009","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1002\/jbmr.1658","article-title":"The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading","volume":"27","author":"AG Bruno","year":"2012","journal-title":"J Bone Miner Res"},{"issue":"9","key":"pone.0312082.ref010","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1007\/s00586-019-06083-1","article-title":"Sagittal balance of the spine.","volume":"28","author":"JC Le Huec","year":"2019","journal-title":"Eur Spine J"},{"issue":"1","key":"pone.0312082.ref011","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00198-018-4704-5","article-title":"European guidance for the diagnosis and management of osteoporosis in postmenopausal women.","volume":"30","author":"Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF).","year":"2019","journal-title":"Osteoporos Int."},{"issue":"2","key":"pone.0312082.ref012","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00198-021-06136-6","article-title":"The association between hyperkyphosis and fall incidence among community-dwelling older adults.","volume":"33","author":"MC Koel\u00e9","year":"2022","journal-title":"Osteoporos Int"},{"issue":"6","key":"pone.0312082.ref013","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s00223-020-00679-2","article-title":"Long-term rates of change in musculoskeletal aging and body composition: findings from the Health, Aging and Body Composition Study","volume":"106","author":"LD Westbury","year":"2020","journal-title":"Calcif Tissue Int"},{"issue":"1","key":"pone.0312082.ref014","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1152\/physrev.00061.2017","article-title":"Sarcopenia: Aging-Related Loss of Muscle Mass and Function","volume":"99","author":"L Larsson","year":"2019","journal-title":"Physiol Rev"},{"issue":"23","key":"pone.0312082.ref015","doi-asserted-by":"crossref","first-page":"E1542","DOI":"10.1097\/BRS.0000000000003680","article-title":"Correlations and Age-Related Changes of Cervical Sagittal Parameters in Adults Without Symptoms of Cervical Spinal Disease.","volume":"45","author":"L Hu","year":"2020","journal-title":"Spine (Phila Pa 1976)."},{"issue":"12","key":"pone.0312082.ref016","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1302\/2058-5241.6.210062","article-title":"Sagittal balance: from theory to clinical practice.","volume":"6","author":"JI Cirillo Totera","year":"2021","journal-title":"EFORT Open Rev"},{"issue":"6","key":"pone.0312082.ref017","doi-asserted-by":"crossref","first-page":"611","DOI":"10.3340\/jkns.2023.0146","article-title":"The Sagittal Balance of Cervical Spine: Comprehensive Review of Recent Update.","volume":"66","author":"SH Lee","year":"2023","journal-title":"J Korean Neurosurg Soc."},{"issue":"6","key":"pone.0312082.ref018","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5535\/arm.23075","article-title":"The Relationship Between Low Back Pain and Sagittal Spinal Alignment and Back Muscle Mass in Korean Fishery Workers.","volume":"47","author":"M Kook","year":"2023","journal-title":"Ann Rehabil Med"},{"issue":"6","key":"pone.0312082.ref019","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1007\/s00586-013-2721-9","article-title":"Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males.","volume":"22","author":"S Imagama","year":"2013","journal-title":"Eur Spine J"},{"issue":"1","key":"pone.0312082.ref020","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13018-023-03602-1","article-title":"The ratio of cervical lordosis to C7 slope represents the reciprocal change between cervical sagittal alignment and global spinal alignment.","volume":"18","author":"DF Wang","year":"2023","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"pone.0312082.ref021","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0974-8237.199877","article-title":"Loss of cervical lordosis: What is the prognosis?","volume":"8","author":"L Lippa","year":"2017","journal-title":"J Craniovertebr Junction Spine"},{"key":"pone.0312082.ref022","doi-asserted-by":"crossref","first-page":"1162425","DOI":"10.3389\/fpubh.2023.1162425","article-title":"Association of grip strength and comorbidities with all-cause mortality in the older hypertensive adults","volume":"11","author":"Y Wang","year":"2023","journal-title":"Front Public Health"},{"issue":"23","key":"pone.0312082.ref023","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1097\/BRS.0000000000001642","article-title":"Variations in Sagittal Alignment Parameters Based on Age: A Prospective Study of Asymptomatic Volunteers Using Full-Body Radiographs.","volume":"41","author":"S Iyer","year":"2016","journal-title":"Spine (Phila Pa 1976)."},{"issue":"2","key":"pone.0312082.ref024","doi-asserted-by":"crossref","first-page":"467","DOI":"10.14245\/ns.2346374.187","article-title":"From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity","volume":"20","author":"Y Cho","year":"2023","journal-title":"Neurospine"},{"key":"pone.0312082.ref025","doi-asserted-by":"crossref","first-page":"1209319","DOI":"10.3389\/fpubh.2023.1209319","article-title":"Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis","volume":"11","author":"M Sadaqa","year":"2023","journal-title":"Front Public Health"},{"issue":"11","key":"pone.0312082.ref026","doi-asserted-by":"crossref","first-page":"e018063","DOI":"10.1136\/bmjopen-2017-018063","article-title":"Relationship between hormone replacement therapy and spinal osteoarthritis: a nationwide health survey analysis of the elderly Korean population","volume":"7","author":"JH Park","year":"2017","journal-title":"BMJ Open"},{"issue":"7","key":"pone.0312082.ref027","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1177\/21925682231152826","article-title":"The Role of Sex Hormones in Degenerative Disc Disease","volume":"13","author":"T Shelby","year":"2023","journal-title":"Global Spine J."},{"issue":"1","key":"pone.0312082.ref028","first-page":"CD012424","article-title":"Exercise for preventing falls in older people living in the community.","volume":"1","author":"C Sherrington","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0312082.ref029","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3390\/nu14010074","article-title":"Nutrition, Physical Activity, and Dietary Supplementation to Prevent Bone Mineral Density Loss: A Food Pyramid.","volume":"14","author":"M Rondanelli","year":"2021","journal-title":"Nutrients"},{"issue":"1","key":"pone.0312082.ref030","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1186\/s12891-022-05711-0","article-title":"Genetic variants of interleukin 1B and 6 are associated with clinical outcome of surgically treated lumbar degenerative disc disease","volume":"23","author":"Genodisc Consortium","year":"2022","journal-title":"BMC Musculoskelet Disord."},{"issue":"3","key":"pone.0312082.ref031","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3390\/healthcare8030343","article-title":"Association of Low Bone Mass with Decreased Skeletal Muscle Mass: A Cross-Sectional Study of Community-Dwelling Older Women.","volume":"8","author":"K Nonaka","year":"2020","journal-title":"Healthcare (Basel)."},{"key":"pone.0312082.ref032","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.2147\/JMDH.S419306","article-title":"Examining Physical Wellness as the Fundamental Element for Achieving Holistic Well-Being in Older Persons: Review of Literature and Practical Application in Daily Life.","volume":"16","author":"ST Hung","year":"2023","journal-title":"J Multidiscip Healthc."},{"issue":"8","key":"pone.0312082.ref033","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s00198-013-2296-7","article-title":"Relationship of thoracic kyphosis and lumbar lordosis to bone mineral density in women","volume":"24","author":"A Pavlovic","year":"2013","journal-title":"Osteoporos Int"},{"issue":"7","key":"pone.0312082.ref034","doi-asserted-by":"crossref","first-page":"e0254381","DOI":"10.1371\/journal.pone.0254381","article-title":"Transiency of postoperative cervical kyphosis seen after surgical correction of sagittal malalignment in adult spinal deformity patients","volume":"16","author":"KY Lee","year":"2021","journal-title":"PLoS One"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T17:27:51Z","timestamp":1730395671000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312082"}},"subtitle":[],"editor":[{"given":"Barry","family":"Kweh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,10,31]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0312082","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,31]]}}}