Osteoporosis and gut microbiota: current understandings

Osteoporosis (OP), a prevalent disease among middle-aged and elderly individuals, is characterized by a decrease in bone mineral density (BMD), which predisposes individuals to fragile fractures. The core pathological process involves excessive bone resorption over bone formation. The etiology of OP is intricate, and increasing recent studies have focused on the role of gut microbiota (GM) in its pathogenesis. Harmful bacteria exacerbate OP, whereas probiotics are beneficial for bone metabolism and delay the progression of OP. GM influences the progression of OP through various mechanisms, including the production of metabolites, modulation of the intestinal barrier, and regulation of intestinal immunity and osteoimmunology. In this review, we summarize the role of GM in the pathogenesis of OP based on the latest understandings, and highlight the promising potential of strategies targeting GM for the intervention and management of OP.