The impact of osteoporosis on the natural course and pathological evolution of intervertebral disc degeneration

• Osteoporosis (OP) affects the vertebral cartilage endplate nutrition and further leads to intervertebral disc degeneration (IVDD), which is related to the degeneration of nucleus pulposus cells. • The internal mechanism of OP affecting IVDD needs further study. • Anti-osteoporosis drugs can improve low back pain and delay IVDD, but the effect of drugs needs evaluation carefully. Osteoporosis (OP) and intervertebral disc degeneration (IVDD) are prevalent age-related conditions. As the global population ages, the incidence of both OP and IVDD continues to rise. Currently, whether OP influences the natural progression and pathological evolution of IVDD remains incompletely defined. We therefore reviewed epidemiological associations, pathophysiological mechanisms, imaging and histopathological evidence, clinical implications, risk predictors, and intervention strategies to elucidate the intrinsic relationship between OP and IVDD. Our analysis indicates that OP may exacerbate the natural course of disc degeneration and worsen pathological outcomes, potentially mediated by endplate cartilage malnutrition and inflammatory cascades within the disc. However, the underlying molecular mechanisms remain poorly characterized, lacking clearly defined signaling pathways and biomarkers. While certain anti-osteoporotic agents demonstrate potential to mitigate disc degeneration, high-quality clinical evidence supporting their efficacy remains limited.