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Review Open Access

Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review)

  • Authors:
    • Jingjing Wu
    • Siqi Zhang
    • Junjie Wu
    • Yuhang Luan
    • Xingchen Yao
    • Boyan Xu
    • Yiting Wang
    • Yingyue Sheng
    • Yuzheng Xue
    • Yilin Ren
  • View Affiliations / Copyright

    Affiliations: Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214122, P.R. China, School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, P.R. China
    Copyright: © Wu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 91
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    Published online on: February 9, 2026
       https://doi.org/10.3892/ijmm.2026.5762
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Abstract

Osteoporosis is a metabolic bone disease marked by decreased bone mineral density and deterioration of bone microarchitecture. Its development involves complex interactions between genetic factors, nutrition, hormones and lifestyle factors. As the global population is aging, osteoporosis has become a public health concern. Although drug treatments such as bisphosphonates and hormone replacement therapy are available, these options are limited by high costs and adverse side effects, highlighting the need for alternative approaches. The gut microbiota is a regulator of bone metabolism through its metabolites, effects on immune function and role in maintaining intestinal barrier integrity, endocrine signaling and nutrient absorption. Exercise, beyond its role in promoting bone strength through mechanical loading, enhances calcium absorption, thereby modulating gut microbiota composition. Within this context, exercise‑based strategies may provide a promising avenue for both osteoporosis prevention and treatment by targeting the gut‑bone axis, however, the underlying molecular mechanisms remain incompletely understood and additional clinical evidence is required. The present review summarizes how exercise‑induced changes in gut microbiota may influence bone health, also discussing the relevance of these to the management of osteoporosis.
View Figures

Figure 1

Aerobic and anaerobic exercise
modulate the gut-bone axis. Based on the gut-bone axis, different
exercise modalities regulate bone metabolism by modulating gut
microbiota composition and promoting beneficial bacterial
proliferation.

Figure 2

Therapeutic effects of gut microbiota
in osteoporosis. SCFAs activate GPCR 41/43/109A, modulating the
balance of Treg/Th17 and their associated cytokine IL-17, thereby
regulating osteoclast differentiation. Dysbiosis of the gut
microbiota leads to elevated levels of LPS and TMAO, which
upregulate the NF-κB signaling and the secretion of inflammatory
cytokines such as TNF-α, exacerbating OS and promoting osteoclast
formation. Isoquercetin inhibits the NF-κB signaling pathway,
modulating the expression of inflammatory signaling pathways and
abnormal cortisol release induced by gut microbiota dysbiosis,
thereby suppressing osteoblast apoptosis and promoting osteoblast
differentiation. SCFAs produced by probiotic metabolism stimulate
the synthesis of IGF-I through the enterohepatic circulation,
forming an HMO-SCFA-IGF-I regulatory axis that promotes osteoblast
differentiation. Bile acids and SCFAs activate the Wnt/β-catenin
signaling pathway in osteoblasts, upregulating FXR and TGR5,
thereby promoting osteoblast differentiation and preventing bone
loss. Lignans inhibit serotonin synthesis by suppressing the
intestinal-specific TPH1 and modulating the composition of the gut
microbiota, thereby indirectly exerting skeletal protective
effects. Chronic hypoxia downregulates HIF-α expression, diminishes
gut microbial diversity and the abundance of Lactobacillus in the
intestinal tract, intensifies OS and induces premature senescence
in BMSCs. Taohong Siwu decoction promotes the development and
differentiation of BMSCs by regulating the structure and function
of the gut microbiota and upregulating the secretion of VEGFs. TMAO
inhibits the osteogenic differentiation of BMSCs. SCFA, short-chain
fatty acid; GPCR, G protein-coupled receptor; Treg, regulatory T
cell; Th, T helper cell; LPS, lipopolysaccharide; TMAO,
trimethylamine N-oxide; OS, oxidative stress; IGF, insulin-like
growth factor; HMO, human milk oligosaccharide; FXR, farnesoid X
receptor; TGR5, Takeda G protein-coupled receptor 5; TPH,
tryptophan hydroxylase; HIF, hypoxia-inducible factor; BMSC, bone
marrow-derived mesenchymal stem cell; HPA,
hypothalamic-pituitary-adrenal axis.

Figure 3

Potential mechanisms of
exercise-mediated gut microbiota in improving bone metabolism.
Exercise enhances the abundance of probiotics such as Lactobacillus
and Bifidobacterium, downregulates the LPS/TLR4/NF-κB inflammatory
signaling pathway and MMP-13 expression, thereby inhibiting
osteocyte apoptosis. Furthermore, exercise decreases the
Firmicutes/Bacteroidetes ratio, upregulates SCFA levels, suppresses
Th17 cell differentiation while increasing Treg populations and
promotes secretion of IL-4, IL-10 and TGF-β1, collectively
inhibiting osteoclastogenesis. Additionally, exercise-mediated gut
microbiota modulation exerts an effect on hormone secretion,
including estrogen, leptin and ghrelin, thereby facilitating
osteoblast differentiation. Exercise also increases microbial
diversity, improves intestinal barrier function and enhances
absorption of proteins, minerals and vitamins by bone cells,
ultimately promoting skeletal health. LPS, lipopolysaccharide; TLR,
toll-like receptor; SCFA, short-chain fatty acid; Th, T helper;
Treg, regulatory T cell; ROS, reactive oxygen species; GHRP, growth
hormone secretagogue receptor ligand.
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Copy and paste a formatted citation
Spandidos Publications style
Wu J, Zhang S, Wu J, Luan Y, Yao X, Xu B, Wang Y, Sheng Y, Xue Y, Ren Y, Ren Y, et al: Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review). Int J Mol Med 57: 91, 2026.
APA
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B. ... Ren, Y. (2026). Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review). International Journal of Molecular Medicine, 57, 91. https://doi.org/10.3892/ijmm.2026.5762
MLA
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B., Wang, Y., Sheng, Y., Xue, Y., Ren, Y."Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review)". International Journal of Molecular Medicine 57.4 (2026): 91.
Chicago
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B., Wang, Y., Sheng, Y., Xue, Y., Ren, Y."Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review)". International Journal of Molecular Medicine 57, no. 4 (2026): 91. https://doi.org/10.3892/ijmm.2026.5762
Copy and paste a formatted citation
x
Spandidos Publications style
Wu J, Zhang S, Wu J, Luan Y, Yao X, Xu B, Wang Y, Sheng Y, Xue Y, Ren Y, Ren Y, et al: Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review). Int J Mol Med 57: 91, 2026.
APA
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B. ... Ren, Y. (2026). Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review). International Journal of Molecular Medicine, 57, 91. https://doi.org/10.3892/ijmm.2026.5762
MLA
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B., Wang, Y., Sheng, Y., Xue, Y., Ren, Y."Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review)". International Journal of Molecular Medicine 57.4 (2026): 91.
Chicago
Wu, J., Zhang, S., Wu, J., Luan, Y., Yao, X., Xu, B., Wang, Y., Sheng, Y., Xue, Y., Ren, Y."Targeting the gut‑bone axis through exercise: A novel approach to osteoporosis prevention and treatment (Review)". International Journal of Molecular Medicine 57, no. 4 (2026): 91. https://doi.org/10.3892/ijmm.2026.5762
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