Journal of Bone and Mineral Metabolism · Nov 1, 2026
Osteoporosis, sarcopenia, locomotive syndrome, and frailty in age-related spinal kyphosis
By Tanishima S, Wada T, Nagashima H
Introduction Age-related kyphosis is a common manifestation of musculoskeletal aging associated with falls, mobility decline, reduced participation, and respiratory compromise in severe cases. This narrative review summarizes its relationships with osteoporosis, sarcopenia, locomotive syndrome, and frailty. Materials and methods PubMed/MEDLINE was searched for English-language publications from database inception through December 31, 2025. Relevant evidence was reviewed narratively. Results Observational studies indicate that osteoporosis-associated vertebral fragility is an important structural contributor to kyphotic progression through clinically apparent or unrecognized vertebral fractures and progressive vertebral deformity. Degenerative disc changes and local trunk muscle dysfunction may also contribute through altered spinal loading and reduced active postural support. Evidence linking generalized sarcopenia to kyphosis remains inconsistent, whereas local trunk muscle dysfunction and poor paraspinal muscle quality may be more directly relevant. Kyphosis may coexist with locomotive syndrome and physical frailty, but these associations do not establish causality. Conclusion Assessment should include bone mineral density, vertebral fracture status, regional and global sagittal alignment, trunk muscle function, and mobility. Management should combine appropriate osteoporosis treatment, trunk-focused exercise, posture training, and nutritional support. Further longitudinal and interventional studies are needed to clarify causal relationships and determine whether treatment preserves mobility and independence.