Research & Education

Potential Role of Gut Health in the Management of Musculoskeletal Conditions

It has been said that “all roads lead to the microbiome.” Countless aspects of health are intertwined with our gut microbiota. The gut–musculoskeletal axis is one of the newer areas under investigation.

Growing evidence suggests there is crosstalk between the gut microbiota and the musculoskeletal system. The “conversations” that take place across this axis could impact musculoskeletal health.

Advancing age is often characterized by intestinal microbial dysbiosis and an increase in bone and joint conditions. Unhealthy shifts in the gut microflora can contribute to an inflammatory state, potentially provoking musculoskeletal issues.

Musculoskeletal Conditions Linked to the Gut Microbiota

Observational and animal research suggests that undesirable alterations in the gut microbiota may contribute to several musculoskeletal disorders. These conditions include:

  • Osteoarthritis (OA)

  • Rheumatoid arthritis (RA)

  • Gout

  • Osteoporosis

  • Sarcopenia 

  • Fibromyalgia

Some of the best evidence linking the gut microbiota to musculoskeletal problems is indicated in OA and RA patients. Research linking gut dysbiosis to sarcopenia, osteoarthritis, and fibromyalgia is growing.

Scientists are investigating how improving gut microbiota health might help counteract musculoskeletal challenges. This is especially important because definitive treatments are limited.

Exploring Probiotics for Musculoskeletal Health

Probiotics may benefit the health of bones and joints through the production of metabolites that diffuse from the gut into the circulation. These metabolites are called postbiotics

Short-chain fatty acids (SCFAs), such as butyrate and propionate, are examples of postbiotics. In animal models, SCFAs have been shown to inhibit bone resorption and stimulate bone formation.

Probiotics may also help by keeping the population of potentially harmful bacteria under control. In vitro and animal research has found that when bacteria release endotoxins, it may stimulate inflammation and bone resorption. 

Scientists are also investigating which probiotics may benefit musculoskeletal health. For example, in vitro research suggests some strains of Lactobacillus plantarum may help protect bone health.

Exploring Prebiotics for Musculoskeletal Health

Prebiotics are nondigestible, fermentable compounds that selectively promote the growth of beneficial microbes. Asparagus, artichokes, garlic, and onions are common prebiotic sources.

Concentrated amounts of prebiotics can be obtained from supplements. Inulin, derived from chicory root, is a prebiotic used in some supplements and in nutrition bars. Oligofructose (a subtype of inulin) may also be added to food products. 

In animal research, prebiotics have increased SCFA generation and bone mineral density. Studies are underway to confirm similar benefits in patients.

Prebiotics may also aid osteoarthritis. When scientists fed obese mice oligofructose, it helped re-establish beneficial Bifidobacteria. This also helped decrease inflammation-promoting microbes and helped mitigate knee joint inflammation and damage after an injury.

Interestingly, glucosamine and chondroitin sulfate may also serve as prebiotics. Their positive influence on the gut microbiota might be one way they support joint health. More research is needed to confirm this. 

Keep in mind, many factors can play a role in dysfunction of the musculoskeletal system. However, addressing gut dysbiosis may prove to be helpful in some cases.

By Marsha McCulloch, MS, RDN, LN