Correlation between gut microbiota and musculoskeletal diseases

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Dysbiosis of the microbiota is linked to an increase in intestinal permeability and a simultaneous reduction in antioxidant functions, contributing to the creation of a chronic inflammatory state that results in weakening and fragility of the musculoskeletal system. Dysbiosis can, in fact, negatively influence the immune system, leading to an increase in the production of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), which can damage joint tissue. In this regard, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) recently stated that several risk factors for osteoarthritis (OA) can interact with the intestinal microbiota, which appears to be a critical determinant of metabolism and bioavailability of OA drugs. Recent scientific evidence shows that changes in the composition of the microbiota, altering intestinal permeability and thus allowing leakage of bacteria and their components into the bloodstream, can trigger a systemic inflammatory reaction capable of contributing to the progression of joint degeneration. It is known that physical exercise can play a key role not only in improving the functioning of patients suffering from OA, but also in terms of modulating the composition of the microbiota, strengthening the immunity of the intestinal mucosa; furthermore, obesity, which is an important risk factor for the development of OA, has been linked to both dysbiosis of the gut microbiota and chronic inflammation, suggesting that complex connections exist between microbiota, obesity, and musculoskeletal pathologies. Intestinal dysbiosis can have a negative impact on bone health by influencing the RANK/RANKL/OPG pathway; in this context, it has been hypothesized that food supplements, prebiotics and probiotics can support an adequate balance of the intestinal microbiota and consequently bone health. In conclusion, the correlation between gut dysbiosis and musculoskeletal diseases, such as OA, sarcopenia, and osteoporosis, is still the subject of research and further studies are necessary to fully understand the underlying mechanisms. KEY WORDS: Microbiota, musculoskeletal diseases, gut, osteosarcopenia.