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This psychological vulnerability arises from a complex web of hormonal shifts, fear of fracture, and significant global sociocultural determinants that restrict care access. This comprehensive narrative review synthesizes current evidence through a biopsychosocial framework, critically examining the underlying psychoneuroimmunology (PNI) mechanisms that govern the bone-mood axis. Furthermore, we evaluate evidence-based psychological therapies (including cognitive behavioral therapy and mindfulness-based interventions) and propose an innovative, hierarchical stepped-care model for long-term patient management. Finally, we identify critical gaps in existing pharmacological and behavioral strategies, offering a multidisciplinary roadmap to advance mental health equity and integrated psychosomatic care for aging female populations.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1906383","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:23:49Z","timestamp":1787239429000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychosomatic interplay in postmenopausal osteoporosis: from neuroendocrine mechanisms to structured psychological therapies and long-term management"],"prefix":"10.3389","volume":"17","author":[{"given":"Haixiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People\u2019s Hospital","place":["Xi\u2019an, China"]},{"name":"Shaanxi Engineering Research Center of Cell Immunology, 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