Exploring the Interaction Between Sjögren’s Syndrome and Osteoporosis: Pathophysiological Mechanisms and Management Strategies

Zhenghao Shi,1,2,* Jiaxu Chen,1,2,* Luan Xue1,2 1Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People’s Republic of China; 2Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Luan Xue, Email [email protected]: Sjögren’s syndrome (SS) is a systemic autoimmune disorder predominantly affecting middle-aged and elderly women, characterized by lymphocytic infiltration of exocrine glands—particularly the salivary and lacrimal glands—resulting in xerophthalmia and xerostomia. Osteoporosis (OP), sharing similar age of onset and gender predilection, is a skeletal disorder defined by reduced bone mineral density and heightened fracture risk. The comorbidity of SS and OP represents a prevalent clinical phenomenon, with studies reporting an incidence rate of 33.1% to 51.6% among SS patients, significantly higher than that observed in healthy elderly populations. Vitamin D metabolism, widespread abnormal immune responses, hormonal imbalances, metabolic acidosis, and the RANKL/RANK/OPG axis exert significant contributory roles in the pathogenesis of both conditions. Treatment regimens for SS and OP may present certain overlaps yet potential contradictions. In this narrative review, we summarize the bidirectional relationship between these two diseases, thoroughly discuss the existing challenges in their management, and emphasize that recommending a comprehensive management strategy for SS patients with concurrent OP is crucial for enhancing patients’ quality of life.Keywords: Sjögren’s syndrome, osteoporosis, immune system, pathophysiological mechanisms