Bone and Muscle Health in Rheumatic Diseases: From Glucocorticoid-Induced Osteoporosis to Osteosarcopenia

Bone and muscle are intimately linked organs, yet their co-pathology in rheumatic diseases remains underrecognised and poorly characterised. Glucocorticoid-induced osteoporosis (GIOP) and sarcopenia frequently co-occur in older adults with chronic rheumatological diseases—a condition termed osteosarcopenia—representing a critical threat to musculoskeletal health, independence, and quality of life. In rheumatic disease populations, bone and muscle loss emerge through multiple convergent pathways: persistent systemic inflammation, disease activity, disease-modifying and immunosuppressive medications (particularly glucocorticoids), altered lipid and microbiota profiles, reduced physical activity, and nutritional insufficiency. GIOP is a particularly prevalent and serious complication in rheumatology practice, affecting bone mineral density and fracture risk; sarcopenia reduces muscle mass, strength, and physical performance. When combined, their synergistic effects substantially amplify fall risk, fracture incidence, disability, and loss of independence. This Research Topic integrates perspectives from GIOP, osteoporosis management and recognition, bone–muscle physiology, and functional aging, shifting focus from isolated bone or muscle pathology to the holistic syndrome of musculoskeletal decline and its real-world impact on activities of daily living —mobility, self-care, community participation—and quality of life, particularly in older adults with rheumatological and systemic inflammatory diseases. We seek to raise awareness and present educational activities to advance understanding of bone and muscle mechanisms, phenotypes, therapeutic responses, and the effectiveness of integrated, evidence-based strategies that restore and sustain independence whilst optimising pharmacological and non-pharmacological interventions. We welcome original research on the following themes: • Epidemiology and pathophysiology of bone and muscle co-loss in rheumatic diseases • Glucocorticoid-induced osteoporosis (GIOP): prevalence, risk stratification, and long-term outcomes in rheumatology populations • Sarcopenia in rheumatic diseases: phenotypic characterisation, prevalence, and functional consequences • Bone–muscle crosstalk: shared mechanisms of osteoporosis and sarcopenia in inflammation and aging • Disease activity biomarkers and their association with bone loss and muscle wasting • Pharmacotherapy for GIOP and osteoporosis in patients with rheumatic diseases: efficacy, safety, and long-term durability • Treatment strategies for GIOP: comparative effectiveness of anti-osteoporotic therapies, sequential and combination therapy • Bone quality in GIOP: assessment of bone quality, bone strength, and fracture risk beyond bone mineral density • Biologic and DMARD effects on bone and muscle in patients with rheumatoid arthritis and other rheumatic diseases • Physical exercise, rehabilitation and training interventions to improve muscle and bone health in GIOP • Falls in rheumatologic patients: risks and particularitiesMultimodal interventions: disease control optimisation, exercise, nutrition, and pharmacotherapy in the integrated management of bone and muscle health Topic editors: Mai Kawazoe, GEORGE SOULIS Source: https://www.frontiersin.org/research-topics/83432/bone-and-muscle-health-in-rheumatic-diseases-from-glucocorticoid-induced-osteoporosis-to-osteosarcopenia