Underlying Mechanisms of Osteoporosis in the Context of Multimorbidity: Clinical Challenges and Management Strategies

TL;DR

This paper reviews how osteoporosis interacts with chronic diseases like diabetes and heart disease, highlighting shared mechanisms and the need for integrated care.

Contribution

The paper emphasizes shared biological pathways and drug effects in multimorbidity, advocating for personalized and multidisciplinary care models.

Findings

Osteoporosis and cardiometabolic diseases share mechanisms like inflammation and hormonal dysregulation.

Integrated care models reduce mortality and refracture rates in multimorbid patients.

Drug interactions and care fragmentation remain significant clinical challenges.

Abstract

Osteoporosis and chronic conditions such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and chronic kidney disease share several common biological mechanisms, including chronic inflammation, oxidative stress, hormonal dysregulation, and metabolic alterations. In this context, multimorbidity presents an increasing clinical challenge, particularly in older populations, where osteoporosis remains frequently underdiagnosed and undertreated. This review aims to explore the complex interplay between skeletal fragility and cardiometabolic diseases, emphasizing the role of nutritional deficiencies (such as iron and vitamin C), shared molecular pathways (advanced glycation end-products, Renin–Angiotensin–Aldosterone System, RANK Ligand, RANK), and the systemic impact of chronic inflammation and tissue hypoperfusion. The review also addresses the effects of various drug classes—antidiabetics, antihypertensives, anticoagulants, and anti-osteoporotic agents—on bone metabolism and cardiovascular risk. Special focus is given to the implementation of integrated and personalized care models, particularly multidisciplinary team-based approaches, which have demonstrated significant reductions in mortality and refracture rates, despite their still limited adoption in clinical practice. In conclusion, this review highlights the shared mechanisms between osteoporosis and cardiometabolic conditions in the context of multimorbidity, underscoring persistent clinical challenges related to diagnosis, drug interactions, and care fragmentation that warrant further research into integrated care models.

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