Association between metabolic syndrome and osteoporosis in older adults: a review

Metabolic syndrome is a condition characterized by abdominal obesity, hypertension, insulin resistance, and disorders of carbohydrate and lipid metabolism. The highest prevalence of metabolic syndrome is observed among older adults. A decline in estrogen levels in postmenopausal women increases the risk of both metabolic syndrome and osteoporosis, especially if associated with vitamin D deficiency. Osteoporosis is one of the most important medical and social problems. Its pathogenesis may be related not only to hormonal changes but also to alterations in the composition of the gut microbiota. Gut microbial dysbiosis in metabolic syndrome is exacerbated by chronic inflammation, inappropriate pharmacotherapy, and comorbid conditions (such as consequences of gastrectomy, bariatric surgery, malabsorption syndrome, atrophic gastritis, and other diseases). These factors can alter microbial metabolites and mineral metabolism, thereby contributing to decreased bone mineral density. Thus, modulation of the microbiota and its metabolites in patients with metabolic syndrome may be considered a promising approach for the prevention and treatment of osteoporosis in older adults.