{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:32:09Z","timestamp":1791232329580,"version":"4.1.0"},"reference-count":108,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Accumulating evidence suggests that SARS-CoV-2 is associated with disruptions in skeletal homeostasis through both direct viral effects on bone-remodeling cells and indirect inflammatory mechanisms, contributing to bone loss and increased skeletal fragility. The maintenance of healthy bone structure depends on the coordinated activities of bone-resorbing osteoclasts and bone-forming osteoblasts. Recent studies demonstrate that differentiated human osteoblasts support productive SARS-CoV-2 infection, whereas MSC and osteoclast precursors undergo abortive infection. These interactions impair osteoblast differentiation, increase IL-6 and receptor activator of nuclear factor \u03baB Ligand (RANKL) expression, and promote osteoclastogenesis, shifting bone remodeling toward pathological resorption. Additional virus-associated mediators, including Spike protein, ORF8, and miR-4485-3p, further amplify inflammatory and pro-osteoclastogenic signaling. Clinical studies report associations between acute and persistent reductions in bone mineral density, increased vertebral fracture prevalence, and alterations in musculoskeletal (MSK) imaging biomarkers associated with worse COVID-19 outcomes, while animal models confirm osteoclast-driven trabecular bone loss. This review integrates emerging evidence of productive and abortive SARS-CoV-2 infection of human bone cells with recent clinical and experimental findings, providing an updated osteoimmunological perspective on COVID-19-associated bone remodeling. Prospective longitudinal studies and clinical trials are needed to determine the long-term skeletal consequences of COVID-19 and evaluate targeted strategies to prevent infection-associated bone loss.<\/jats:p>","DOI":"10.3389\/fendo.2026.1897220","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:06:07Z","timestamp":1785762367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The effects of SARS-CoV-2 on bone homeostasis"],"prefix":"10.3389","volume":"17","author":[{"given":"M. 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