Common in later life, and it doesn't fade with ageStrong evidence
Low back pain affected 619 million people worldwide in 2020, and how common it is, and the disability it causes, rise with age to a peak at about 85, with women more affected, more so over 75 (modelled estimates). The idea that back pain eases after the mid-50s holds only for milder pain: most population studies that measured severe back pain found it becoming more common with age.
Of 5,304 people aged 65 and over registered with Oxfordshire general practices, 34% had back pain, a further 19.5% had back pain with leg pain, and 11.2% had symptoms that fit spinal stenosis; those with back pain reported more falls, frailty, low confidence walking and loss of mobility. In people aged 75 and over in Cambridge, 6% had back pain that disabled them and 23% back pain that didn't, and studies of people aged 60 to 102 put the figure anywhere from 21% to 75%, depending on the question asked. Poor self-rated health, low mood and earlier back pain predicted new back pain in the Cambridge group: links, not proof of cause, but a reason to look after mood and general health alongside the back.
Sources 1, 2, 3, 4, 5
Spinal stenosis: the classic later-life patternEmerging evidence
Spinal stenosis is a narrowing of the spaces in the spine that hold the nerves. In the lower back, NHS inform says, it can cause pain, aching, cramping, heaviness, weakness, tingling or numbness in the legs, usually worse with walking or standing and relieved by sitting or leaning forward. Most narrowing is a normal part of ageing and often causes no problems, and low back pain without leg symptoms usually isn't from stenosis. It is diagnosed in about 11% of the general population and 25% of people seen with back pain in general practice, from studies mostly at high risk of bias, and 9.3% of 1,009 Japanese adults (average age 66) had both the symptoms and narrowing on a scan.
Narrowed leg arteries (peripheral arterial disease) can feel similar: a painful ache in the legs on walking that usually goes after a few minutes' rest, more likely if you smoke or have diabetes, and the NHS says many people mistakenly think it's just part of growing older. Leaning forward improved walking distance in 11 of 19 people with the stenosis pattern in a small study, but walking and cycling tests didn't reliably tell the two apart, so leg ache on walking needs a GP's check.
Sources 6, 7, 8, 9, 10
Spinal fractures from thin bones: common, and often quietStrong evidence
A spinal fracture (a vertebral or compression fracture) is when a weakened bone in the spine squashes. In 15,570 people aged 50 to 79 in 19 European countries, 12% of women and 12% of men had a squashed vertebra on an X-ray, more often with age, rising more steeply in women. They often follow little or no injury: 83% of diagnosed spinal fractures in a US town followed moderate or no injury. Of 107 people seen in a Swedish emergency unit with a new fracture (average age about 75), 65.4% had fallen from standing height or had a minor injury, and 34.6% remembered no event at all. The NHS says a cough or sneeze can sometimes cause one of the bones of the spine to partly collapse.
Many are never diagnosed. In a large trial of older women, only about 1 in 4 new squashed vertebrae seen on X-rays (22.6% of 446) had been diagnosed in the community; in an international study of 2,451 women, local X-ray reports missed 34% of spinal fractures; and the UK osteoporosis guideline says most remain undiagnosed. Not every spinal fracture hurts: the signs are back pain or a change in body shape, such as height loss or a curved back, the Royal Osteoporosis Society says. Of 669 people over 55 who saw a GP in the Netherlands with back pain, 5% were diagnosed with a spinal fracture within a year, more often at 75 or over, after an injury, with known osteoporosis, with severe pain or with pain in the middle or upper back.
Sources 11, 12, 13, 14, 15, 16, 17, 18, 19
Scans: mostly ageing, and when a test helpsStrong evidence
In people with no back pain, scans showed disc wear in 88% at 60, 93% at 70 and 96% at 80; disc bulges in 69%, 77% and 84%; wear in the small facet joints in 50%, 69% and 83%; and a slipped vertebra (spondylolisthesis) in 23%, 35% and 50% (33 studies of 3,110 people). The authors call these part of normal ageing. NICE says don't routinely offer imaging for low back pain outside specialist care, and in specialist care only if the result is likely to change what happens. NHS inform says most back problems don't need an X-ray or a magnetic resonance imaging (MRI) scan, and in 5,239 adults aged 65 and over, early X-rays or scans weren't linked with better recovery at a year.
Tests answer specific questions. Spine X-rays, or a side view of the spine on a bone density scanner, look for a spinal fracture after sudden back pain in someone at risk of osteoporosis, or with height loss of 4 cm or more, a rounded upper back or long-term steroid tablets, and a bone health check follows. The cauda equina signs need emergency assessment in hospital, and suspected pressure on the spinal cord in someone with cancer and nerve signs needs an MRI scan within 24 hours. NICE asks for blood tests for myeloma at 60 and over with persistent bone pain, particularly back pain, or an unexplained fracture, and an urgent scan for pancreatic cancer at 60 and over with weight loss and back pain. A suspected spinal infection needs a blood test for inflammation and an MRI scan, since the fever and nerve signs may not all be there at first. An ultrasound scan finds an aortic aneurysm, and men in England are offered one the year they turn 65.
The warning signs aren't perfect: single signs such as being over 50 raise many false alarms, while a past cancer (for cancer) or a significant injury, long-term steroid tablets and being over 70 (for a fracture) carry more weight, and several together more still.
Sources 20, 21, 22, 23, 17, 24, 25, 26, 27, 28, 29
An aneurysm, cancer and infection: rare, with their own signsStrong evidence
An abdominal aortic aneurysm is a swelling of the main artery in the tummy. It often causes no symptoms, though as it gets bigger it can cause tummy or back pain or a pulsing feeling in the tummy, and sudden, severe tummy or back pain can mean it has burst, which needs 999. It is most common in men aged 65 and over and in people who smoke or used to smoke: men in England are invited for screening the year they turn 65, and 1.34% of the first 700,000 men screened had one. Women get them less often, but NICE says a woman's is more likely to burst, so the 999 signs apply to everyone.
Cancer explains 0% to 0.66% of back pain seen in primary care (6 studies, 6,622 people), though a past cancer raises the chance considerably. NICE asks GPs to offer blood tests for myeloma, a cancer of the bone marrow, at 60 and over with persistent bone pain, particularly back pain, or an unexplained fracture. Myeloma can bring bone pain in the back, hips, shoulders or ribs, tiredness, thirst and weight loss, and about 6,532 people a year are diagnosed with it in the UK. With a past or current cancer, back pain that is severe and doesn't let up, keeps getting worse, or is worse at night or when you strain needs the cancer team's advice within 24 hours, NICE says.
An infection in the spine is rare: 2.2 rising to 5.8 cases per 100,000 people a year in one Danish county, highest over 70. Back pain and fever are the commonest symptoms, and diabetes the commonest underlying illness. In one series, 27% of 260 spinal bone infections followed a procedure on the spine, and in 63 people with an abscess next to the spinal cord, back pain, fever and nerve problems were all present in only 13% at the first visit, so a fever isn't always there. A kidney infection also causes back or side pain with a high temperature (the warning signs).
So the causes that need a quicker look have their own clues: sudden, severe tummy or back pain with collapse (an aneurysm); back pain with a fever or feeling unwell (an infection); constant or night pain, weight loss or a past cancer (rarely cancer). Ordinary back pain and stenosis change with movement and position and come and go, and a spinal fracture usually hurts most when you move and less when you lie down.
Sources 30, 31, 32, 28, 29, 25, 33, 34, 24, 35, 36, 37, 26, 38
Polymyalgia rheumatica and shinglesStrong evidence
Polymyalgia rheumatica causes pain and stiffness around both shoulders and often the neck and hips, worst in the morning for more than 45 minutes, mostly in people over 65; the British Society for Rheumatology's 2026 guideline says about 1% of people in the UK have it. Neither the NHS nor that guideline lists low back pain as a feature, so stiff shoulders, neck and hips, rather than the low back, are the clue. Some people with it develop temporal arteritis (giant cell arteritis): up to 1 in 5, the NHS says, while the guideline gives about 5% to 10%; its signs are in the warning signs.
Shingles can start as a tingling or painful patch of skin on one side of the body, often the chest or tummy, with a rash a few days later, and rarely it causes pain without a rash. See a pharmacist, ideally within 3 days of the rash appearing (the NHS).
Sources 39, 40, 41, 42
How it usually goesEmerging evidence
The NHS says back pain usually improves within a few weeks but can last longer or keep coming back, and NHS inform expects the biggest change in the first couple of weeks and most problems to improve within 6 weeks; both are written for adults of any age. In later life it more often lingers. In 5,211 people aged 65 and over who saw a doctor with a new episode, most of the improvement came in the first 3 months, 44.8% had at least 30% less pain at a year, and 23.0% said it had gone completely. In the Oxfordshire cohort, 23% of those with back pain had none 2 years later. Staying active is still what helps, even when pain lingers.
Spinal stenosis usually changes slowly. Without surgery, about a third of people improve, about half stay the same and 10% to 20% get worse over up to 3 years; in 146 people (average age 68) followed for about 3 years, leg pain was better in 32%, unchanged in 55% and worse in 13%. NHS inform says any progression is usually slow, and that the nerves can learn to adapt to the narrowed space. No one can promise a timescale.
Sources 43, 22, 44, 3, 45, 46, 6
How a spinal fracture heals: two different picturesMixed evidence
The Royal Osteoporosis Society says a spinal fracture takes 6 to 12 weeks to heal, that you can usually expect it to heal within about 3 months, and that the pain usually gets better as it heals, though for some people it doesn't go away completely. But in 107 people seen in a Swedish emergency unit with a new, painful spinal fracture, pain had improved only 10% to 15% by 3 months and changed little after that, up to a year.
The two disagree, so the honest answer is that the bone usually heals within about 3 months, many people improve as it does, and some have pain for longer. Staying as active as you can helps, the society says, and movement doesn't affect the healing.
Sources 47, 48, 13
