ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Parity, menopausal timing, and spinopelvic mismatch: a moderated mediation analysis of low back pain in postmenopausal women.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the association of parity and menopausal timing with spinopelvic alignment in postmenopausal women and whether pelvic incidence-lumbar lordosis (PI-LL) difference statistically mediates the association between parity and low back pain.
methodsThis single-centre cross-sectional study included 239 postmenopausal women aged ≥ 45 years. Standardised standing lumbosacral radiographs were used to measure pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, and PI-LL difference. PI-LL mismatch was defined as ≥ 10°. Pain severity was assessed using a visual analogue scale. Multivariable regression and mediation analyses were performed.
resultsHigher parity was associated with greater pelvic incidence, sacral slope, and PI-LL difference. Pelvic incidence differed significantly across parity groups (nulliparous, 1-2 deliveries, and ≥ 3 deliveries) (H(2) = 30.163, p < 0.001), with median values of 43.80° (40.30-47.50) in nulliparous women and 48.35° (44.80-51.30) in women with ≥ 3 deliveries. Earlier menopausal age was associated with greater PI-LL difference. PI-LL mismatch was present in 25.5% of women and was associated with higher pain severity (p < 0.001).
conclusionHigher parity and earlier menopausal age were associated with differences in measured spinopelvic parameters, particularly PI-LL difference. Reproductive history and menopausal timing may be clinically relevant when interpreting low back pain in postmenopausal women. LEVEL OF EVIDENCE: IV.
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