{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:07:38Z","timestamp":1788505658769,"version":"build-2803163510"},"reference-count":93,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Low back pain (LBP) is a leading cause of disability worldwide, with its burden increasing due to population growth and ageing. Postmenopausal women are disproportionately affected, largely owing to estrogen decline, which accelerates osteoporosis and intervertebral disc degeneration. This study aimed to quantify the global, regional, and national burden of LBP among postmenopausal women from 1990 to 2021, using data from the Global Burden of Disease (GBD) Study 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed prevalence, incidence, and disability-adjusted life years (DALYs) of LBP in women aged 55 years and older across 204 countries and territories from 1990 to 2021. Temporal trends were assessed using age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs). Contributions of three modifiable risk factors\u2014high body-mass index (BMI), smoking, and occupational or environmental exposures\u2014were examined by Socio-demographic Index (SDI) quintiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Between 1990 and 2021, incident cases nearly doubled (from 35.2 million to 70.3 million), prevalent cases rose from 89.9 million to 176.8 million, and DALYs increased from 9.8 million to 19.1 million. Despite these increases, age-standardized incidence, prevalence, and DALY rates declined modestly. In 2021, the burden in postmenopausal women was 1.78 times higher for incidence, 1.86 times higher for prevalence, and 1.84 times higher for DALYs than in age-matched men. High BMI was the leading modifiable risk factor globally, contributing to 14.2% of DALYs, followed by occupational or environmental risks (12.6%) and smoking (7.3%). Regional variation was marked: high and high-middle SDI regions showed declining ASRs, whereas middle and low-middle SDI regions experienced increases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The global burden of LBP among postmenopausal women has risen substantially, despite declines in age-standardized rates. High BMI, occupational exposures, and smoking are key modifiable drivers, with varying impacts by development level. Public health strategies should prioritize weight management, workplace interventions, and smoking cessation, with particular focus on high-risk age groups and low-resource regions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1683183","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:12:23Z","timestamp":1758859943000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["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"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiaxian","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jot.2021.07.005","article-title":"Global, regional and national burden of low back pain 1990-2019: A systematic analysis of the Global Burden of Disease study 2019","volume":"32","author":"Chen","year":"2022","journal-title":"J Orthop Translat"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30488-4","article-title":"Low back pain: a call for action","volume":"391","author":"Buchbinder","year":"2018","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"Itc113","DOI":"10.7326\/AITC202108170","article-title":"Low back pain","volume":"174","author":"Chou","year":"2021","journal-title":"Ann Intern Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s2665-9913(23)00098-x","article-title":"Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001499","article-title":"Does vitamin D status influence lumbar disc degeneration and low back pain in postmenopausal women? A retrospective single-center study","volume":"27","author":"Xu","year":"2020","journal-title":"Menopause"},{"key":"B6","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1186\/s13063-024-08364-7","article-title":"Efficacy and safety of minodronate in the treatment of postmenopausal osteoporosis with low back pain: a single-centre, randomized and open-label controlled trial","volume":"25","author":"Wang","year":"2024","journal-title":"Trials"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.687551","article-title":"T-cell mediated inflammation in postmenopausal osteoporosis","volume":"12","author":"Wu","year":"2021","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/s0140-6736(21)00733-9","article-title":"Low back pain","volume":"398","author":"Knezevic","year":"2021","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/nu13124556","article-title":"Energy metabolism changes and dysregulated lipid metabolism in postmenopausal women","volume":"13","author":"Ko","year":"2021","journal-title":"Nutrients"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0256720","article-title":"Is adiposity associated with back and lower limb pain? A systematic review","volume":"16","author":"Peiris","year":"2021","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-23-0116","article-title":"Postmenopausal osteoporosis coexisting with sarcopenia: the role and mechanisms of estrogen","volume":"259","author":"Lu","year":"2023","journal-title":"J Endocrinol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"H752","DOI":"10.1152\/ajpheart.00724.2023","article-title":"Sleep disturbance and sympathetic neural reactivity in postmenopausal females","volume":"326","author":"Tahsin","year":"2024","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"E255","DOI":"10.1097\/gme.0000000000001961","article-title":"Chronic low back pain and sleep disturbance in adults in the US: the NHANES 2009\u20132010 study","volume":"27","author":"Tong","year":"2024","journal-title":"Pain Physician"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001961","article-title":"Mental health and quality of life in postmenopausal women as a function of retrospective menopause symptom severity","volume":"29","author":"Hooper","year":"2022","journal-title":"Menopause"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2022.05.006","article-title":"Does sleep quality modify the relationship between common mental disorders and chronic low back pain in adult women","volume":"96","author":"Barazzetti","year":"2022","journal-title":"Sleep Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1136\/bjsports-2020-103596","article-title":"Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis","volume":"56","author":"Gianola","year":"2022","journal-title":"Br J Sports Med"},{"key":"B17","article-title":"Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews","volume":"4","author":"Cashin","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B18","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1186\/s12891-024-07599-4","article-title":"Current trends in the medical treatment of neuropathic low back pain: a Swedish registry-based study of 1.7 million people","volume":"25","author":"Nyqvist","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-017198","article-title":"Global burden of osteoarthritis among postmenopausal women in 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021","volume":"10","author":"Xu","year":"2025","journal-title":"BMJ Glob Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s13075-025-03587-8","article-title":"Global burden and trends of musculoskeletal disorders in postmenopausal elderly women: a 1990\u20132021 analysis with projections to 2045","volume":"27","author":"Tan","year":"2025","journal-title":"Arthritis Res Ther"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"395","year":"2020","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30752-2","article-title":"Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1521567","article-title":"Low back pain trends attributable to high body mass index over the period 1990\u20132021 and projections up to 2036","volume":"11","author":"Zhang","year":"2024","journal-title":"Front Nutr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1186\/s40001-025-02765-3","article-title":"High-BMI-related low back pain in China: a GBD-based observational study on sex-age trends and projections (1990-2021)","volume":"30","author":"Xu","year":"2025","journal-title":"Eur J Med Res"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20010840","article-title":"Musculoskeletal disorder burden and its attributable risk factors in China: estimates and predicts from 1990 to 2044","volume":"20","author":"Yu","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/nu13093208","article-title":"The effect of dietary interventions on chronic inflammatory diseases in relation to the microbiome: A systematic review","volume":"13","author":"Wagenaar","year":"2021","journal-title":"Nutrients"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S190440","article-title":"Health-related quality of life in Romanian postmenopausal women with osteoporosis and fragility fractures","volume":"13","author":"Ciubean","year":"2018","journal-title":"Clin Interv Aging"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1495-8","article-title":"Alendronate is more effective than elcatonin in improving pain and quality of life in postmenopausal women with osteoporosis","volume":"22","author":"Iwamoto","year":"2011","journal-title":"Osteoporos Int"},{"key":"B29","doi-asserted-by":"publisher","first-page":"111909","DOI":"10.1016\/j.exger.2022.111909","article-title":"Association of back pain with major depressive disorder among older adults in six low- and middle-income countries: A cross-sectional study","volume":"167","author":"Selvamani","year":"2022","journal-title":"Exp Gerontol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"20040","DOI":"10.1038\/s41598-022-24703-7","article-title":"Chronic low back pain and its impact on physical function, mental health, and health-related quality of life: a cross-sectional study in Singapore","volume":"12","author":"Ge","year":"2022","journal-title":"Sci Rep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jot.2016.05.012","article-title":"Menopause as a potential cause for higher prevalence of low back pain in women than in age-matched men","volume":"8","author":"Wang","year":"2017","journal-title":"J Orthop Translat"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2015.09.001","article-title":"Postmenopausal Chinese women show accelerated lumbar disc degeneration compared with Chinese men","volume":"3","author":"Wang","year":"2015","journal-title":"J Orthop Translat"},{"key":"B33","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1161\/CIRCRESAHA.124.325535","article-title":"Sex-specific factors influencing obesity in women: bridging the gap between science and clinical practice","volume":"136","author":"Ayesh","year":"2025","journal-title":"Circ Res"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12359","article-title":"Muscle mass measures and incident osteoporosis in a large cohort of postmenopausal women","volume":"10","author":"Papageorgiou","year":"2019","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B35","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1002\/jcsm.12547","article-title":"Muscle and bone mass in middle-aged women: role of menopausal status and physical activity","volume":"11","author":"Sipil\u00e1","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsac272","article-title":"The circadian variation of sleep and alertness of postmenopausal women","volume":"46","author":"P\u00e9rez-Medina-Carballo","year":"2023","journal-title":"Sleep"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7622","article-title":"Temporal analysis of chronic musculoskeletal pain and sleep in postmenopausal women","volume":"15","author":"Frange","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1186\/s12905-022-01710-4","article-title":"Biopsychosocial risk factors of depression during menopause transition in southeast China","volume":"22","author":"Chu","year":"2022","journal-title":"BMC Womens Health"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22041568","article-title":"Critical role of estrogens on bone homeostasis in both male and female: from physiology to medical implications","volume":"22","author":"Emmanuelle","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2007.07.025","article-title":"Estrogen prevents bone loss via estrogen receptor alpha and induction of Fas ligand in osteoclasts","volume":"130","author":"Nakamura","year":"2007","journal-title":"Cell"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202102_25075","article-title":"Protective effect of estrogen receptors (ER\u03b1\/\u03b2) against the intervertebral disc degeneration involves activating CCN5 via the promoter","volume":"25","author":"Song","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B42","doi-asserted-by":"publisher","first-page":"115862","DOI":"10.1016\/j.bone.2021.115862","article-title":"Peak trabecular bone microstructure predicts rate of estrogen-deficiency-induced bone loss in rats","volume":"145","author":"Li","year":"2021","journal-title":"Bone Apr"},{"key":"B43","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1186\/s12891-019-2916-2","article-title":"Vertebral bone marrow fat fraction changes in postmenopausal women with breast cancer receiving combined aromatase inhibitor and bisphosphonate therapy","volume":"20","author":"Dieckmeyer","year":"2019","journal-title":"BMC Musculoskelet Disord"},{"key":"B44","doi-asserted-by":"publisher","first-page":"E510","DOI":"10.1097\/BRS.0000000000002904","article-title":"Estrogen deficiency exacerbates intervertebral disc degeneration induced by spinal instability in rats","volume":"44","author":"Liu","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2347342.671","article-title":"Proteoglycan dysfunction: A common link between intervertebral disc degeneration and skeletal dysplasia","volume":"21","author":"Sao","year":"2024","journal-title":"Neurospine"},{"key":"B46","doi-asserted-by":"publisher","first-page":"103346","DOI":"10.1016\/j.jri.2021.103346","article-title":"Menopause is an inflection point of age-related immune changes in women","volume":"146","author":"Han","year":"2021","journal-title":"J Reprod Immunol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1611932","article-title":"Oxidative stress and\u2002inflammation: roles\u2002in\u2002osteoporosis","volume":"16","author":"Luo","year":"2025","journal-title":"Front Immunol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"109825","DOI":"10.1016\/j.intimp.2023.109825","article-title":"Activation of estrogen receptor \u03b1 inhibits TLR4 signaling in macrophages and alleviates the instability of atherosclerotic plaques in the postmenopausal stage","volume":"116","author":"Meng","year":"2023","journal-title":"Int Immunopharmacol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3892\/mmr.2019.10014","article-title":"Estrogen receptor \u03b2 suppresses inflammation and the progression of prostate cancer","volume":"19","author":"Xiao","year":"2019","journal-title":"Mol Med Rep"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-19-0518","article-title":"JAK2\/STAT3 regulates estrogen-related senescence of bone marrow stem cells","volume":"245","author":"Wu","year":"2020","journal-title":"J Endocrinol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.2174\/1871530320666200604160614","article-title":"Are oxidative stress and inflammation mediators of bone loss due to estrogen deficiency? A review of current evidence","volume":"20","author":"Mohamad","year":"2020","journal-title":"Endocr Metab Immune Disord Drug Targets"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.1052429","article-title":"Endocrinal metabolic regulation on the skeletal system in post-menopausal women","volume":"13","author":"Thapa","year":"2022","journal-title":"Front Physiol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)30818-8","article-title":"Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015","volume":"390","year":"2017","journal-title":"Lancet"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.06.003","article-title":"New trends on obesity and NAFLD in Asia","volume":"67","author":"Fan","year":"2017","journal-title":"J Hepatol"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30204-3","article-title":"Epidemiology and determinants of type 2 diabetes in south Asia","volume":"6","author":"Hills","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1598278","article-title":"Burden analysis of diabetic nephropathy caused by excessive intake of sugar-sweetened beverages in high and low SDI regions","volume":"13","author":"Wang","year":"2025","journal-title":"Front Public Health"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-023-05500-5","article-title":"Musculoskeletal disorders and pain in agricultural workers in Low- and Middle-Income Countries: a systematic review and meta-analysis","volume":"44","author":"Shivakumar","year":"2024","journal-title":"Rheumatol Int"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1080\/1059924X.2020.1713273","article-title":"Work-related musculoskeletal symptoms among agricultural workers: A cross-sectional study in Iran","volume":"25","author":"Momeni","year":"2020","journal-title":"J Agromed"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.3233\/wor-210433","article-title":"Ergonomic and psychosocial risk factors for low back pain among rice farmers in West Bengal, India","volume":"72","author":"Das","year":"2022","journal-title":"Work"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5278.173992","article-title":"Prevalence, pattern, and factors associated with work-related musculoskeletal disorders among pluckers in a tea plantation in Tamil Nadu, India","volume":"19","author":"Vasanth","year":"2015","journal-title":"Indian J Occup Environ Med"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1186\/s12889-022-13730-8","article-title":"Prevalence and risk factors analysis for low back pain among occupational groups in key industries of China","volume":"22","author":"Jia","year":"2022","journal-title":"BMC Public Health"},{"key":"B62","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/BRS.0000000000001665","article-title":"Behavior-related factors associated with low back pain in the US adult population","volume":"43","author":"Yang","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"B63","doi-asserted-by":"publisher","first-page":"487","DOI":"10.14245\/ns.2448372.186","article-title":"Comparative review of the socioeconomic burden of lower back pain in the United States and globally","volume":"21","author":"Chang","year":"2024","journal-title":"Neurospine"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2023.03.014","article-title":"Longitudinal associations of body mass index and abdominal circumference with back pain among community-dwelling adults: data from the Osteoarthritis Initiative","volume":"23","author":"Li","year":"2023","journal-title":"Spine J"},{"key":"B65","doi-asserted-by":"publisher","first-page":"110392","DOI":"10.1016\/j.jbiomech.2021.110392","article-title":"Increasing BMI increases lumbar intervertebral disc deformation following a treadmill walking stress test","volume":"121","author":"Coppock","year":"2021","journal-title":"J Biomech"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001356","article-title":"Effect of obesity and being overweight on disability and pain after lumbar fusion: an analysis of 805 patients","volume":"41","author":"Sorimachi","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-014-3425-5","article-title":"Has overweight any influence on the effectiveness of conservative treatment in patients with low back pain","volume":"24","author":"Daentzer","year":"2015","journal-title":"Eur Spine J"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11010011","article-title":"The association of kinesiophobia and pain catastrophizing with pain-related disability and pain intensity in obesity and chronic lower-back pain","volume":"11","author":"Varallo","year":"2020","journal-title":"Brain Sci"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2024.02.006","article-title":"Time trends in the burden of low back pain and its associated risk factors in China from 1990 to 2019","volume":"45","author":"Zhang","year":"2024","journal-title":"J Orthop Translat"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.1061\/(ASCE)CO.1943-7862.0001320","article-title":"Assessing work-related risk factors on low back disorders among roofing workers","author":"Wang","year":"2017","journal-title":"J Constr Eng Manage"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18105474","article-title":"The prevalence of and risk factors associated with musculoskeletal disorders in thai oil palm harvesting workers: A cross-sectional study","author":"Bhuanantanondh","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2011.01.014","article-title":"On the quantitative relationships between individual\/occupational risk factors and low back pain prevalence using nonparametric approaches","volume":"78","author":"Mendelek","year":"2011","journal-title":"Joint Bone Spine"},{"key":"B73","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1186\/s12889-025-23178-1","article-title":"Global burden of low back pain from 1990 to 2021: a comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021","volume":"25","author":"Yang","year":"2025","journal-title":"BMC Public Health"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1573828","article-title":"Global burden of occupational ergonomic factor-induced low back pain, 1990~2021: data analysis and projections of the global burden of disease","volume":"13","author":"Wu","year":"2025","journal-title":"Front Public Health"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25520","article-title":"Global trends in risk factors for low back pain. An analysis of the GBD study data from 1990 to 2021","author":"Roberts","year":"2025","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"B76","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/s41413-019-0050-2","article-title":"Connexin 43 hemichannels protect bone loss during estrogen deficiency","volume":"7","author":"Ma","year":"2019","journal-title":"Bone Res"},{"key":"B77","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1038\/s41413-023-00280-x","article-title":"Low back pain and osteoarthritis pain: a perspective of estrogen","volume":"11","author":"Pang","year":"2023","journal-title":"Bone Res"},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.23070","article-title":"Psychosocial work stressors, high family responsibilities, and psychological distress among women: A 5-year prospective study","volume":"63","author":"Gilbert-Ouimet","year":"2020","journal-title":"Am J Ind Med"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16183250","article-title":"Emotional exhaustion in housewives and alzheimer patients\u2019 Caregivers: its effects on chronic diseases, somatic symptoms and social dysfunction","author":"Campos-Puente","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.13167","article-title":"Caregiving activities closely associated with the development of low-back pain among female family caregivers","volume":"25","author":"Suzuki","year":"2016","journal-title":"J Clin Nurs"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5816","article-title":"What contextual factors account for anxiety and depressed mood in hospice family caregivers","volume":"31","author":"Tay","year":"2022","journal-title":"Psychooncology"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22052604","article-title":"An overview of the molecular mechanisms contributing to musculoskeletal disorders in chronic liver disease: osteoporosis, sarcopenia, and osteoporotic sarcopenia","volume":"22","author":"Yang","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B83","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1186\/s12877-024-05263-z","article-title":"Performance of calf circumference in identifying sarcopenia in older patients with chronic low back pain: a retrospective cross-sectional study","volume":"24","author":"Kim","year":"2024","journal-title":"BMC Geriatr"},{"key":"B84","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.14179","article-title":"Grip strength is a strong indicator of osteoporosis in both women and men with chronic liver disease","author":"Ichikawa","year":"2025","journal-title":"Hepatol Res"},{"key":"B85","doi-asserted-by":"publisher","first-page":"105341","DOI":"10.1016\/j.jpain.2025.105341","article-title":"Chronic musculoskeletal pain and its association with cognitive function and sarcopenia in older adults: characterization and change over three months","author":"Oliveira","year":"2025","journal-title":"J Pain"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e31828763a0","article-title":"Functional pain severity and mobility in overweight older men and women with chronic low-back pain\u2013part I","volume":"92","author":"Vincent","year":"2013","journal-title":"Am J Phys Med Rehabil"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaa426","article-title":"Markers of cardiovascular health in older adults with and without chronic low back and radicular leg pain: A comparative analysis","volume":"22","author":"Coyle","year":"2021","journal-title":"Pain Med"},{"key":"B88","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1016\/j.jamda.2019.04.013","article-title":"Coexistence of chronic musculoskeletal pain and depressive symptoms and their combined and individual effects on onset of disability in older adults: A cohort study","volume":"20","author":"Murata","year":"2019","journal-title":"J Am Med Dir Assoc"},{"key":"B89","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/ageing\/afz134","article-title":"Influence of the number and severity of comorbidities in the course of acute non-specific low back pain in older adults: longitudinal results from the Back Complaints in the Elders (BACE-Brazil)","volume":"49","author":"Leopoldino","year":"2019","journal-title":"Age Ageing"},{"key":"B90","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002779","article-title":"The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care","volume":"164","author":"Vigdal","year":"2023","journal-title":"Pain"},{"key":"B91","doi-asserted-by":"publisher","first-page":"55","DOI":"10.23736\/S1973-9087.23.07649-9","article-title":"The relationship between chronic diseases and the intensity and duration of low back pain","volume":"60","author":"Alsubaie","year":"2024","journal-title":"Eur J Phys Rehabil Med"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.03.025","article-title":"Associations of multiple chronic conditions with physical performance and falls among older adults with back pain: A longitudinal, population-based study","volume":"102","author":"Rundell","year":"2021","journal-title":"Arch Phys Med Rehabil"},{"key":"B93","doi-asserted-by":"publisher","first-page":"299","DOI":"10.2147\/CIA.S503349","article-title":"Evaluation of waist-calf circumference ratio to assess sarcopenia in older patients with chronic low back pain: A retrospective observational study","volume":"20","author":"Kim","year":"2025","journal-title":"Clin Interv Aging"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1683183\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:12:25Z","timestamp":1758859945000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1683183\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":93,"alternative-id":["10.3389\/fendo.2025.1683183"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1683183","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"article-number":"1683183"}}