Postbiotics and Musculoskeletal Health: Emerging Applications in Bone, Muscle, and Joint Care

Postbiotics are non-viable microbial components or metabolic byproducts derived from probiotics, emerging as stable, safe, and efficacious alternatives to traditional probiotics and prebiotics.These bioactive compounds, including short-chain fatty acids (SCFAs), exopolysaccharides (EPS), and bacteriocins, exert systemic health benefits through mechanisms such as immunomodulation, gut barrier reinforcement, and metabolic regulation.While their roles in gastrointestinal, immune, and metabolic health are well-documented, their potential in musculoskeletal health remains underexplored despite compelling preclinical and clinical evidence.This review synthesizes current knowledge on postbiotics, with a novel focus on their applications in bone, muscle, and joint health.SCFAs like butyrate enhance bone mineral density by modulating the gut-bone axis, suppressing osteoclastogenesis, and improving calcium absorption.In muscle, postbiotics mitigate sarcopenia and cachexia by reducing inflammatory cytokines (like TNF-) and enhancing mitochondrial function via aryl hydrocarbon receptor (AhR) activation.For joint health, EPS from lactic acid bacteria inhibit cartilage-degrading enzymes (MMP-3/-13), offering therapeutic promise in osteoarthritis.Clinical trials highlight postbiotic formulations improving bone density in postmenopausal women, grip strength in the elderly, and pain scores in osteoarthritis patients.Innovations in functional foods such as EPS-fortified supplements and lyophilized powders demonstrate translational potential, though challenges in bioavailability and dosing persist.Future directions emphasize personalized nutrition, multi-omics integration, and synergistic therapies combining postbiotics with bisphosphonates or myostatin inhibitors.By bridging microbiome science and musculoskeletal medicine, this review underscores postbiotics as transformative agents for aging populations, athletes, and chronic disease management, advocating for accelerated research to unlock their full clinical potential.