# Impact of Menopause and Associated Hormonal Changes on Spine Health in Older Females: A Review

## TL;DR

Menopause-related hormonal changes may worsen spine health in older women, but the exact causes are unclear, and exercise and parathyroid hormone show promise in treating related back pain.

## Contribution

This review identifies hormonal effects on spinal tissues and highlights gaps in understanding mechanisms and effective treatments for menopause-related low back pain.

## Key findings

- Menopausal hormone changes are linked to spine tissue degeneration and systemic inflammation.
- Exercise and parathyroid hormone show more promise than hormone replacement therapy for treating menopause-related low back pain.
- Most evidence is correlational, and causal mechanisms remain poorly understood.

## Abstract

What are the main findings?
Menopausal hormone fluctuations are associated with intervertebral disc degeneration, facet joint osteoarthritis, ligamentum flavum hypertrophy, sarcopenia, sympathetic innervation alterations, and systemic inflammation; however, specific mechanisms remain poorly understood.Evidence suggests exercise and parathyroid hormone are promising therapeutic options for menopausal low back pain (LBP), while hormone replacement therapy and bisphosphonates seem less promising.

Menopausal hormone fluctuations are associated with intervertebral disc degeneration, facet joint osteoarthritis, ligamentum flavum hypertrophy, sarcopenia, sympathetic innervation alterations, and systemic inflammation; however, specific mechanisms remain poorly understood.

Evidence suggests exercise and parathyroid hormone are promising therapeutic options for menopausal low back pain (LBP), while hormone replacement therapy and bisphosphonates seem less promising.

What are the implications of the main findings?
This review highlights critical windows for research to uncover mechanisms and inform improved, targeted treatments for menopause related LBP.

This review highlights critical windows for research to uncover mechanisms and inform improved, targeted treatments for menopause related LBP.

Low back pain (LBP) represents a major societal and economic burden, with annual costs in the United States estimated at $90–134.5 billion. LBP disproportionately impacts postmenopausal women relative to age-matched men, suggesting a role for sex-specific biological factors. Although the mechanisms underlying this disparity are not fully understood, hormonal imbalance during menopause may contribute to LBP pathophysiology. This narrative review aimed to elucidate the impact of menopause on LBP, with emphasis on hormonal effects on spinal tissues and systemic processes. A literature search was conducted, followed by screening of titles, abstracts, and full texts of original clinical studies, preclinical research using human or animal samples, and relevant reviews. Rigour and reproducibility were evaluated using the ARRIVE Guidelines and the Modified Downs & Black Checklist. Evidence indicates that menopause is associated with changes in intervertebral discs, facet joint, ligamentum flavum, skeletal muscle, sympathetic innervation, and systemic systems such as the gut microbiome. However, most findings are correlational rather than causal. Evidence supporting hormone replacement therapy for LBP remains inconclusive, whereas exercise and other treatments, including parathyroid hormones, show more consistent benefits. Future studies should focus on causal mechanisms and adhere to rigour guidelines to improve translational potential.