A 68-year-old woman reports worsening back pain associated with leg symptoms. What is the most likely underlying condition related to her symptoms?

The most likely underlying condition related to the symptoms of worsening back pain associated with leg symptoms in a 68-year-old woman is spinal stenosis. This condition is characterized by the narrowing of the spinal canal, which can lead to compression of the spinal cord and nerve roots. In older adults, degenerative changes in the spine, such as osteoarthritis or disc degeneration, commonly contribute to spinal stenosis.

Patients with this condition often present with back pain as well as neurogenic claudication, which manifests as leg pain, weakness, or cramping that is exacerbated by standing or walking and relieved by sitting or bending forward. This presentation aligns with the symptoms described in the question.

While other conditions like a herniated disc or a vertebral fracture may also cause back pain and leg symptoms, they are less common in this age group or are typically associated with more acute presentations. Osteoporosis can lead to fractures but does not directly cause leg pain related to neurological compression as seen in spinal stenosis. Thus, given the patient's age and symptomatology, spinal stenosis stands out as the most likely cause of her symptoms.