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

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.