Mechanisms and precision interventions in sarcopenia and osteoarthritis comorbidity: A narrative review

Sarcopenia and osteoarthritis are two common musculoskeletal disorders that often coexist, posing significant challenges in clinical management. These conditions share underlying mechanisms such as chronic inflammation, metabolic dysfunction, and biomechanical stress, which accelerate musculoskeletal degeneration. Sarcopenia, characterized by muscle loss and weakness, and osteoarthritis, marked by cartilage degradation and joint dysfunction, frequently overlap, leading to increased disability and reduced quality of life. The presence of both conditions creates a detrimental cycle where muscle weakness exacerbates joint pain, and joint dysfunction further weakens muscles. This comorbidity complicates treatment, requiring integrated strategies that address both muscle and joint pathology. Advances in personalized therapies, driven by multi-omics technologies, are crucial in targeting these interconnected conditions more effectively. Precision medicine, using genetic, metabolic, and physiological data, can help tailor treatments and improve patient outcomes. Furthermore, the integration of adaptive interventions, digital twin models, and real-time feedback systems will play key roles in refining individualized treatment plans. Multi-omics integration and real-world evidence are also transforming how clinical trials are designed and how we assess disease progression, moving away from structural markers to functional and patient-centered outcomes. Effective interventions must involve early detection, personalized approaches, and interdisciplinary care, aiming to break the cycle of degeneration and improve patients' functional independence and quality of life.

This review identifies the biomechanical, metabolic, and epigenetic "vicious cycles" that drive the comorbidity of sarcopenia and osteoarthritis. By integrating multi-omics data, digital twin modeling, and real-time biomechanical feedback, this work provides a framework for clinical precision medicine. The clinical significance lies in identifying a "mechanical window of opportunity" for early intervention-using personalized exercise and nutritional strategies to restore joint homeostasis and prevent irreversible functional decline.