Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review

Abstract

Female sex hormones play an important role in the etiology and pathophysiology of a variety of musculoskeletal degenerative diseases. Postmenopausal women show accelerated disc degeneration due to relative estrogen deficiency. This literature review aims to validate or falsify this hypothesis, i.e., while overall females have higher prevalence of low back pain (LBP) across all age groups, this male vs. female difference in LBP prevalence further increases after female menopause age. The literature search was performed on PubMed on January 2, 2016. The search word combination was (low back pain) AND prevalence AND [(males OR men) AND (females OR women)].The following criteria were taken to include the papers for synthetic analysis: (I) only English primary literatures on nonspecific pain; (II) only prospective studies on general population, but not population with occupational LBP causes, of both males and female subjects studied using the same LBP criterion, ages-specific information available, and males and female subjects were agematched; (III) studies without major quality flaws. In total 98 studies with 772,927 subjects were analyzed.According to the information in the literature, participant subjects were divided into four age groups: (I) school age children group: 6-19 years; (II) young and middle aged group: 20-50 years; (III) mixed age group: data from studies did not differentiate age groups; (IV) elderly group: ≥50 years old. When individual studies were not weighted by participant number and each individual study is represented as one entry regardless of their sample size, the median LBP prevalence ratio of female vs. males was 1.310, 1.140, 1.220, and 1.270 respectively for the four age groups. When individual studies were weighted by participant number, the LBP prevalence ratio of female vs. males was 1.360, 1.127, 1.185, and 1.280 respectively for the four groups.The higher LBP prevalence in school age girls than in school age boys is likely due to psychological factors, female hormone fluctuation, and menstruation. Compared with young and middle aged subjects, a further increased LBP prevalence in females than in males was noted after menopause age.

Mapping the association between back pain and type 2 diabetes: A cross-sectional and longitudinal study of adult Spanish twins

“…In our sample, most females were in their mid-life period (mean age: 54 years), which coincides with the timing of menopausal age [46]. As the majority of women with type 2 diabetes are older and frequently diagnosed during or after menopause [39], the understanding of underlying mechanisms of back pain and degeneration in this population may deserve further exploration.…”

“…estrogen) can affect the immune system and increase the inflammatory response, which may result in a greater predisposition to develop diabetes and spine degeneration [38–43]. Higher prevalence of back pain and more rapid changes in spine degeneration have been reported in females after menopause [39, 41–45]. In our sample, most females were in their mid-life period (mean age: 54 years), which coincides with the timing of menopausal age [46].…”

Factors related with low back pain and pelvic pain at the early stage of pregnancy in Japanese women

“…However, a causal relationship between LBPP and working was not found. Given that physical and psychological factors related to jobs have also been reported to be predictors for lumbar pain (Wáng et al, 2016), a prospective longitudinal study is needed to determine the relationship between LBPP and working.…”

Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up

“…Spondylolisthesis is one of the common disorders in lumbar spine region, and often results in lumbar stenosis, with symptoms of lower back pain, leg pain, neurogenic claudication and decreased function (1)(2)(3)(4). Surgical intervention is recommended if the symptoms can't be relieved by conservative therapy (5)(6)(7)(8)(9)(10).…”