The multi-faceted nature of age-associated osteoporosis

Abstract

Age-associated osteoporosis (AAOP) poses a significant health burden, characterized by increased fracture risk due to declining bone mass and strength. Effective prevention and early treatment strategies are crucial to mitigate the disease burden and the associated healthcare costs. Current therapeutic approaches effectively target the individual contributing factors to AAOP. Nonetheless, the management of AAOP is complicated by the multitude of variables that affect its development. Main intrinsic and extrinsic factors contributing to AAOP risk are reviewed here, including mechanical unloading, nutrient deficiency, hormonal disbalance, disrupted metabolism, cognitive decline, inflammation and circadian disruption. Furthermore, it is discussed how these can be targeted for prevention and treatment. Although valuable as individual targets for intervention, the interconnectedness of these risk factors result in a unique etiology for every patient. Acknowledgement of the multifaceted nature of AAOP will enable the development of more effective and sustainable management strategies, based on a holistic, patient-centered approach.

Keywords: Age-associated osteoporosis; Fracture risk; Osteoporosis etiology; Personalized care; Prevention strategies.

Graphical abstract

Fig. 1

Age-related changes in intrinsic and extrinsic factors impact bone health, contributing to osteoporosis. These factors, whether independently or in combination, disrupt bone remodeling, resulting in diminished mass, strength, and an increased risk of fractures. E = estrogen, T = testosterone, GH = growth hormone, DHEA = Dehydroepiandrosterone, GC = glucocorticoid, PTH = parathyroid hormone, OP = osteoporosis.