Narrative review: age-related transitions in low back pain pathology across the lifespan
This narrative review describes low back pain as a dynamic life-course process: the pathological focus shifts from spondylolysis in adolescent athletes to disc problems in young adulthood, degenerative changes and spinal balance in middle and older adulthood, and sarcopenia, osteoporosis and fragility fractures in late-old age. [1]
Automatic summary · not editorially reviewed
The key findings
The review frames low back pain as a dynamic life-course process rather than a static diagnostic entity. [1]
In middle and older adulthood (60+), global spinal balance replaces localized pathology as the primary determinant of disability. [1]
For late-old adults (80+), the clinical landscape is dominated by the synergistic impacts of sarcopenia and osteoporosis. [1]
The source at a glance
- Study type / format
- Narrative review (abstract)
- Population / context
- People with low back pain across the lifespan, from adolescent athletes to adults aged 80 and older
- Summary based on
- Study abstract
- Original publication
- September 17, 2026
Life-course framing of low back pain
The review treats low back pain as a dynamic process across life rather than a static diagnosis. It notes that low back pain is the leading global cause of years lived with disability and burdens health-related quality of life and healthcare systems. The authors searched PubMed, Scopus and Web of Science for clinical trials, cohorts and reviews published up to January 2026.
Supporting source [1]
Shifting pathology from adolescence to older adulthood
In adolescence the focus is mainly mechanical stress-induced spondylolysis among young athletes. In young adulthood the emphasis shifts to intervertebral disc health, with symptomatic herniation and Modic changes, and psychosocial "Yellow Flags" gain relevance for predicting chronicity. By middle and older adulthood (60+), cumulative degenerative changes affect both discs and facet joints, often appearing as lumbar spinal stenosis and sagittal malalignment; global spinal balance then replaces localized pathology as the main determinant of disability.
Supporting source [1]
Late-old age: sarcopenia, osteoporosis and red flags
For late-old adults (80+), the review says the clinical picture is dominated by the combined effects of sarcopenia and osteoporosis, and assessment shifts from flexibility to functional standing and walking capacity. It reports a high prevalence of fragility fractures and the potential for serious "red flag" conditions, which it says require a high index of clinical suspicion. The authors conclude that low back pain is not static but an evolving process across the lifespan.
Supporting source [1]
How to interpret this
This is an abstract of a narrative review; the full text was not reviewed. The abstract reports a literature search but no quantitative synthesis, effect sizes or study-level results, and it does not describe how many studies were included or how they were assessed. The age-stage descriptions are general characterizations, not tested causal relationships.
Based on the study abstract; the full paper, tables and supplementary data were not reviewed.
Source & supporting passages
Ikemoto T, Hirasawa A, Wakao N. · europepmc.org · September 17, 2026