Metabolic Optimization Before Orthobiologic Therapies (MOBOT): A Narrative Review

Area of Science:

• Orthopedics
• Regenerative Medicine
• Metabolic Health

Background:

• Orthobiologic therapies (e.g., platelet-rich plasma [PRP], concentrated bone marrow aspirate [cBMA]) efficacy is influenced by patient's systemic biological factors.
• Metabolic factors like obesity, insulin resistance, chronic inflammation, sarcopenia, dysbiosis, poor sleep, smoking, and alcohol use can impair tissue regeneration and reduce orthobiologic effectiveness.

Purpose of the Study:

• To review evidence on modifiable metabolic factors impacting musculoskeletal regeneration and orthobiologic outcomes.
• To identify strategies for optimizing metabolic health to enhance regenerative potential and orthobiologic therapy success.

Main Methods:

• Narrative review of preclinical and clinical studies.
• Searches conducted in PubMed, Embase, and Scopus through July 2025.
• Included studies assessed the impact of metabolic factors on musculoskeletal regeneration and orthobiologic outcomes.

Main Results:

• Evidence-based strategies for metabolic optimization include exercise, nutrition, pharmacologic interventions, sleep regulation, microbiome support, and behavioral counseling.
• Preclinical and some clinical data support the plausibility, safety, and potential efficacy of these interventions.
• Optimizing metabolic factors can improve tissue responsiveness, reduce variability, and enhance orthobiologic therapy outcomes.

Conclusions:

• Pre-treatment metabolic optimization improves the biological environment and regenerative outcomes for orthobiologic therapies.
• Screening and managing factors like insulin resistance, chronic inflammation, and poor sleep are crucial.
• Further high-quality research, including randomized controlled trials, is needed to validate and personalize these optimization strategies.