Eje intestino–sistema osteomioarticular: mecanismos fisiopatológicos y aplicaciones clínicas.

Introduction: The gut microbiota influences immunological, endocrine, and metabolic processes that affect bone, muscle, and joint homeostasis. This gut–osteomyoarticular axis integrates bacterial metabolites, cytokines, and intestinal hormones; its dysregulation is associated with osteoporosis, sarcopenia, and inflammatory joint diseases. Objective: To review the pathophysiological mechanisms linking the gut microbiota to the osteomyoarticular system and to explore potential clinical applications. Methods: Narrative review with systematized methods (PRISMA 2020). Sources: PubMed/MEDLINE, Scopus/Embase, and Web of Science (2015–2025). Predefined eligibility criteria, dual screening, risk-of-bias assessment (RoB2, ROBINS-I, JBI, SYRCLE), and certainty grading (GRADE). Of 612 records identified, 58 studies were included in qualitative synthesis. Results: Gut dysbiosis increases intestinal permeability and lipopolysaccharide translocation, activating TLR4 receptors in bone and cartilage, which promotes chronic inflammation and matrix degradation. Th17/Treg imbalance enhances osteoclastogenesis, whereas short-chain fatty acids stimulate osteoblast and muscle function. Probiotic and prebiotic interventions have shown anti-inflammatory and osteoprotective effects in animal models and pilot human studies. Conclusions: The gut–osteomyoarticular axis is an emerging field with promising clinical applications. Its modulation through nutritional strategies and targeted therapies may contribute to the prevention and treatment of bone and joint metabolic disorders.