Sacral Slope as an Early Marker of Postural Change in Postmenopausal Women with Low Bone Mass

To assess the relationship between bone mineral density (BMD) and sagittal spinopelvic alignment in postmenopausal women with low bone mass.

Ninety-two postmenopausal women diagnosed with osteopenia or osteoporosis based on DEXA T-scores were retrospectively analyzed. Spinopelvic parameters-sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis (LL)-were measured using lateral radiographs. Clinical and demographic variables were compared between groups using appropriate statistical methods.

Among all parameters, only SS showed a statistically significant difference between osteoporotic and osteopenic women (p = 0.037). No significant correlations were found between BMD and parity, menopause age, or vitamin D levels. Osteoporotic women had lower SS values. Other spinopelvic and demographic parameters did not differ significantly between groups.

Alterations in SS may represent early postural and biomechanical adaptations to declining bone strength in postmenopausal women. As a determinant of sagittal alignment, SS influences pelvic orientation and lumbar curvature. Its reduction may signal a forward shift in the center of gravity, increasing fall risk. Incorporating SS evaluation into standard imaging may aid early identification of at-risk individuals. Prospective studies are needed to confirm its clinical relevance and predictive value for fractures and functional decline.