If you suffer from back pain, you have plenty of company—it’s the leading cause of global disability, and one of the top reasons people call in sick to work.

But could it also increase your chances of dying early? A new study published in the European Journal of Pain suggests that might be a possibility.

Researchers looked at 4,390 Danish twins age 70 and older, and discovered that those with back pain had a 13 percent higher risk of dying from any cause, compared to those without pain.

Because the study was done in twins, researchers were able to rule out genetic factors for earlier death, senior author Paulo Ferreira, Ph.D., of the University of Sydney said in a news release. The findings are significant since many people think that back pain isn’t life threatening—but this shows the aches may actually serve as a red flag when it comes to health risks.

Although the researchers couldn’t establish causation—it might not be the back pain that’s actually causing your premature death, for instance—Ferreira did note that there’s a link between spinal pain and poor general health, including limited functional ability. And that can trigger some serious health issues: Lost functional ability has a cascading effect that can lead to lower aerobic capacity and less muscle mass, which may lead to immobility and other dangers.

For example, if you’re in chronic pain and getting less exercise, it could prompt feelings of depression. In turn, that could affect sleep, nutritional choices, stress levels, and self-esteem. Factors like these, especially when combined, might increase mortality risk.

The problem is exacerbated if medications and surgery don’t work, Ferreira said. “The best treatment for low back pain is a healthy lifestyle, including physical activity,” he noted. “People need to get moving.” (This is the best workout to prevent back pain.)