Systematic review links gut microbiota dysbiosis to CKD-MBD, RA, OA, and OP pathogenesis.

This systematic review evaluates the association between gut microbiota dysbiosis and various metabolic bone diseases, including chronic kidney disease-mineral and bone disorder (CKD-MBD), rheumatoid arthritis, osteoarthritis, and osteoporosis. The study population and specific sample size were not reported in the available evidence. The review synthesizes findings regarding the mechanisms by which gut microbiota influences these conditions.

Interventional strategies targeting gut microbiota are noted to have the potential to regulate the gut-kidney-bone axis and improve bone health. However, the review does not report specific absolute numbers, p-values, confidence intervals, or effect sizes for these outcomes. The evidence indicates that gut microbiota dysbiosis is a key regulatory factor in CKD-MBD development and progression. Mechanistically, dysbiosis drives chronic low-grade inflammation by impairing the intestinal barrier and promoting endotoxin translocation. Metabolite alterations include reduced short-chain fatty acids and the accumulation of uremic toxins. Additionally, dysregulation of the FGF23-Klotho axis and parathyroid hormone (PTH) is observed in CKD-MBD. The review notes a coexistence of shared dysbiosis and disease-specific characteristics in CKD, RA, OA, and OP.

Safety and tolerability data were not reported for the interventional strategies discussed. The study limitations include the absence of reported adverse events, serious adverse events, discontinuations, or specific follow-up durations. Funding sources and potential conflicts of interest were not reported. The practice relevance is that management of metabolic bone diseases and chronic kidney disease is entering the era of microbiome medicine. Clinicians should interpret these findings as preliminary observations rather than established causal relationships due to the observational nature of the underlying data and the lack of quantitative precision in the reported results.