Musculoskeletal biomarkers in health and disease: implications for the aging spine-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence

Tej D Azad¹, Marvin W Li², Chiu Ping-Yeh³, Kristen E Jones^{4

5}, Elizabeth L Lord⁶, Camilo A Molina⁷, Corey T Walker⁸, Joseph A Osorio⁹, Javier Pizones¹⁰, Alekos Theologis¹¹, Miranda van Hooff^{12

13}, Mitsuru Yagi¹⁴, Michael P Kelly¹⁵, Marinus de Kleuver¹³, Serena S Hu¹⁶, Suken A Shah¹⁷, Ferran Pellisé¹⁸, Jeremy D Walston¹⁹, Robert K Eastlack²⁰, Christopher P Ames³; Scoliosis Research Society Adult Spinal Deformity Task Force on Senescence

Affiliations

¹ Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA. tazad1@jhmi.edu.
² Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Neurosurgery, Duke University, Durham, NC, USA.
⁵ Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
⁶ Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁷ Department of Neurological Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁹ Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.
¹⁰ Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain.
¹¹ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
¹³ Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁴ Department of Orthopaedic Surgery, International University of Health and Welfare, Tochigi, Japan.
¹⁵ Department of Orthopaedic Surgery, University of California San Diego/Rady Children's Hospital, San Diego, CA, USA.
¹⁶ Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA.
¹⁷ Department of Orthopaedic Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE, USA.
¹⁸ Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain.
¹⁹ Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁰ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.

PMID: 40465097
DOI: 10.1007/s43390-025-01124-w

Review

Musculoskeletal biomarkers in health and disease: implications for the aging spine-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence

Tej D Azad et al. Spine Deform. 2025.

. 2025 Jun 4.

doi: 10.1007/s43390-025-01124-w. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA. tazad1@jhmi.edu.
² Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Neurosurgery, Duke University, Durham, NC, USA.
⁵ Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
⁶ Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁷ Department of Neurological Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁹ Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.
¹⁰ Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain.
¹¹ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
¹³ Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁴ Department of Orthopaedic Surgery, International University of Health and Welfare, Tochigi, Japan.
¹⁵ Department of Orthopaedic Surgery, University of California San Diego/Rady Children's Hospital, San Diego, CA, USA.
¹⁶ Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA.
¹⁷ Department of Orthopaedic Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE, USA.
¹⁸ Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain.
¹⁹ Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁰ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.

PMID: 40465097
DOI: 10.1007/s43390-025-01124-w

Abstract

The incidence of spine-related pathologies is expected to increase in developed countries due to ongoing fundamental demographic shifts toward an older population. These changes present significant challenges to public health, as healthcare systems worldwide must confront the burden of musculoskeletal aging and its related consequences. Here, we synthesize current knowledge on the biologic mechanisms underlying musculoskeletal aging, focusing on the implications for the aging spine. The complexity of the aging process, characterized by a convoluted interplay between genetic, environmental, and lifestyle factors, necessitates a comprehensive understanding of the biologic processes and reliable methods of surveying biologic states to inform effective diagnostic, predictive, and prognostic strategies. Biomarkers emerge as invaluable tools in this domain, offering insights into the early detection, risk assessment, and targeted intervention for age-related musculoskeletal decline. This review highlights various biomarker types including diagnostic, predictive, and prognostic, and explores their distinct roles in enhancing our understanding of musculoskeletal aging. Navigating the interconnected landscape of cellular senescence, sarcopenia, osteoporosis, and frailty, this review underscores the critical importance of developing personalized care approaches for the aging population. By identifying and integrating functional biomarkers, researchers and clinicians can elucidate the underlying mechanisms and devise tailored strategies to alleviate the musculoskeletal decline associated with the aging process. We envision an "active surveillance" future where biomarkers of musculoskeletal aging are integrated into clinical practice, empowering clinicians to make proactive, data-driven decisions that improve spine health for older adults.

Keywords: Aging; Cellular senescence; Frailty; Musculoskeletal biomarkers; Spine surgery.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose.

References

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Musculoskeletal biomarkers in health and disease: implications for the aging spine-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence

Affiliations

Musculoskeletal biomarkers in health and disease: implications for the aging spine-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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