Original Article| Volume 28, ISSUE 2, P315-320, March 2023

Sex differences between the relationship of trunk muscle mass and whole body sagittal plane alignment in older adults

Published:January 07, 2022DOI:



      This study aimed to clarify sex differences in the relationship between trunk muscle mass, aging, and whole-body sagittal alignment.


      Subjects aged 60–89 years who underwent musculoskeletal screening in 2018 were included in the study. Subject demographics, trunk muscle mass (TMM) measured by bioelectrical impedance analysis (BIA), and spinopelvic and lower extremity alignment parameters measured from standing radiographic images were investigated. Additionally, TMM was corrected for BMI (TMM/BMI). The relationship between trunk muscle and whole-body sagittal alignment was analyzed for each age group (young-old group (60–74 years) and old–old group (>75 years)) and sex.


      A total of 281 (mean age 75.4 ± 6.7 years, 100 males and 181 females) were enrolled. The trunk muscle mass in both men and women significantly decreased with age. Regarding TMM/BMI, there was no significant difference in men, but there was a significant difference between females in the young-old and old–old groups (p < 0.001). TMM/BMI was significantly correlated with sagittal vertical axis (SVA) and knee flexion angle (KF) in both sexes. In females, TMM/BMI was significantly correlated with thoracic kyphosis in the young-old group, whereas in the old–old group, TMM/BMI was correlated with SVA, PI-LL, and KF.


      TMM was related to trunk anteverion and lower extremity alignment in both sexes. However, the relationship between TMM on alignment differs between sexes. Thoracic hyperkyphosis in young-old adults indicated a decrease in muscle mass, which may be a sign of future malalignment.
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