{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:11:46Z","timestamp":1775146306018,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Locomotive syndrome (LS) is a major cause of mobility impairment and loss of independence in older adults. Abdominal morphology and patterns of body fat distribution are thought to affect physical function; however, their relationships with the severity of LS in women with osteoporosis remain insufficiently characterized. Standing sacral\u2013abdominal wall distance (SAD) is considered an indicator of compromised trunk support mechanisms, whereas the android\/gynoid fat ratio (A\/G ratio) primarily reflects body fat distribution patterns. Methods: This retrospective cross-sectional study included 221 women aged 65 years or older attending an osteoporosis outpatient clinic. LS was assessed using the stand-up test, the two-step test, and the Locomo 25 questionnaire according to official criteria. The most severe stage among the three tests was defined as the overall LS stage, and participants were classified into LS stage 0\u20131 and LS stage \u2265 2 groups. Associations of SAD and the A\/G ratio with LS were examined using multivariable logistic regression analysis adjusted for age, skeletal muscle mass index (SMI), femoral neck T-score, and the Controlling Nutritional Status (CONUT) score. Results: Among the participants, 93 (42.1%) were classified as having LS stage \u2265 2. The LS stage \u2265 2 group had a significantly greater SAD than the LS stage 0\u20131 group (median, 167.3 mm vs. 154.6 mm; p &lt; 0.001), whereas no significant difference was observed in the A\/G ratio (p = 0.054). In multivariable analyses (n = 208), SAD was independently associated with LS stage \u2265 2 (odds ratio per 1 mm increase, 1.035; 95% confidence interval, 1.016\u20131.054; p &lt; 0.001), corresponding to an odds ratio of 1.41 per 10 mm increase. The A\/G ratio also showed an independent association, while no significant interaction between SAD and the A\/G ratio was observed. Conclusions: In women with osteoporosis, SAD was independently associated with LS severity, reflecting mobility impairment from a perspective distinct from body fat distribution. SAD may serve as a simple and clinically useful indicator for assessing the risk of severe LS.<\/jats:p>","DOI":"10.3390\/medicina62040674","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:14:43Z","timestamp":1775142883000},"page":"674","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Standing Sacral\u2013Abdominal Wall Distance and Android\/Gynoid Fat Distribution with Locomotive Syndrome in Older Women"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-1182","authenticated-orcid":false,"given":"Takashi","family":"Nagai","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"},{"name":"Department of Orthopaedic Surgery, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takako","family":"Tachikawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eriko","family":"Hoshi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"},{"name":"Department of Orthopaedic Surgery, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Nishida","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanae","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-1776","authenticated-orcid":false,"given":"Mizuki","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihito","family":"Kasai","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0469-3361","authenticated-orcid":false,"given":"Yoshifumi","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuyuki","family":"Kawate","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Showa Medical University, Tokyo 142-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jos.2022.11.021","article-title":"Locomotive syndrome affects the acquisition of long-term care insurance system certification","volume":"29","author":"Kitaura","year":"2024","journal-title":"J. Orthop. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.afos.2018.09.001","article-title":"Overcoming osteoporosis and beyond: Locomotive syndrome or dysmobility syndrome","volume":"4","author":"Yi","year":"2018","journal-title":"Osteoporos. Sarcopenia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2147\/CIA.S201974","article-title":"Lumbar spinal stenosis associated with progression of locomotive syndrome and lower extremity muscle weakness","volume":"14","author":"Kasukawa","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.1097\/BSD.0000000000001009","article-title":"Relationship Between Muscle Mass of the Lower Limbs and Falls Caused by Spinal Misalignment in Women Aged 70 Years: A Retrospective Study","volume":"34","author":"Ito","year":"2021","journal-title":"Clin. Spine Surg."},{"key":"ref_5","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":"Larsson","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1007\/s00774-019-01012-0","article-title":"Prevalence and co-existence of locomotive syndrome, sarcopenia, and frailty: The third survey of Research on Osteoarthritis\/Osteoporosis Against Disability (ROAD) study","volume":"37","author":"Yoshimura","year":"2019","journal-title":"J. Bone Miner. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/rco2.81","article-title":"Relationship between sacral-abdominal wall distance and grip strength in postmenopausal osteoporotic patients","volume":"6","author":"Nagai","year":"2023","journal-title":"JCSM Rapid Commun."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Nagai, T., Miyagami, M., Okano, I., Nakamura, S., Okazaki, Y., Sakamoto, K., Kasai, F., Kudo, Y., and Kawate, N. (2023). Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study. Nutrients, 15.","DOI":"10.3390\/nu15112571"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110387","DOI":"10.1016\/j.ejrad.2022.110387","article-title":"Ultrasonographic measurement of abdominal and gluteal-femoral fat thickness as a predictor for android\/gynoid ratio","volume":"154","author":"Prasetyo","year":"2022","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1002\/ehf2.12657","article-title":"Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure","volume":"7","author":"Sherveninas","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_11","unstructured":"Japanese Orthopaedic Association (2026, February 21). Locomotive Syndrome Risk Test. Available online: https:\/\/locomo-joa.jp\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.jos.2020.01.011","article-title":"Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20\u201389 years: A cross-sectional nationwide study in Japan","volume":"25","author":"Yamada","year":"2020","journal-title":"J. Orthop. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nagai, T., Miyagami, M., Nakamura, S., Sakamoto, K., Ishikawa, K., Okano, I., Kasai, F., Kudo, Y., and Kawate, N. (2024). Relationship between sacral-abdominal wall distance, movement performance, and spinal alignment in osteoporosis: A retrospective study. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04865-x"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rinninella, E., Borriello, R., D\u2019Angelo, M., Galasso, T., Cintoni, M., Raoul, P., Impagnatiello, M., Annicchiarico, B.E., Gasbarrini, A., and Mele, M.C. (2023). COntrolling NUTritional Status (CONUT) as Predictive Score of Hospital Length of Stay (LOS) and Mortality: A Prospective Cohort Study in an Internal Medicine and Gastroenterology Unit in Italy. Nutrients, 15.","DOI":"10.3390\/nu15061472"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/jdi.12888","article-title":"Effects of liraglutide, metformin and gliclazide on body composition in patients with both type 2 diabetes and non-alcoholic fatty liver disease: A randomized trial","volume":"10","author":"Feng","year":"2019","journal-title":"J. Diabetes Investig."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nistor, I.M., Fica, S., Martin, S.C., Mustata, T., Oprea, T.E., Sirbu, A.E., and Barbu, C.G. (2024). DXA Android-to-Gynoid Ratio and Cardiovascular Risk Assessment in Age and BMI Propensity-Matched Early Postmenopausal Women. Medicina, 60.","DOI":"10.3390\/medicina60071096"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1093\/mr\/roab024","article-title":"Relationship between locomotive syndrome and frailty in rheumatoid arthritis patients by locomotive syndrome stage","volume":"32","author":"Sobue","year":"2022","journal-title":"Mod. Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.afos.2024.07.001","article-title":"Verification of grip strength as an evaluation tool for locomotive syndrome in rheumatoid arthritis","volume":"10","author":"Sobue","year":"2024","journal-title":"Osteoporos. Sarcopenia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1080\/14397595.2017.1308454","article-title":"Comparison of the effects of denosumab with either active vitamin D or native vitamin D on bone mineral density and bone turnover markers in postmenopausal osteoporosis","volume":"28","author":"Suzuki","year":"2018","journal-title":"Mod. Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20200026","DOI":"10.2490\/prm.20200026","article-title":"Comparison of the Effects of Native Vitamin D and Eldecalcitol on Muscular Strength and Dynamic Balance in Patients with Postmenopausal Osteoporosis","volume":"5","author":"Miyakoshi","year":"2020","journal-title":"Prog. Rehabil. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/674\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:42:01Z","timestamp":1775144521000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["medicina62040674"],"URL":"https:\/\/doi.org\/10.3390\/medicina62040674","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}