Osteoporotic Vertebral Compression Fracture (OVCF) is a skeletal injury with a high rate of disability among the elderly. Its occurrence and healing extend far beyond a mere mechanical issue[1][2]. Recent studies indicate that age-related decline in immune function (immunosenescence) and the consequent chronic low-grade inflammatory state ("inflammaging") serve as a key intrinsic mechanism driving osteoporosis progression, increasing fracture risk, and impairing repair capacity[3][4].This article aims to systematically elaborate on how the aging immune system affects the entire process of OVCF occurrence and healing by disrupting osteoimmune homeostasis. Specifically, hallmarks of immunosenescence, such as the contraction of the T-cell repertoire, dysfunction of innate immune cells, and persistently elevated levels of pro-inflammatory cytokines (e.g., IL-6, TNF-α, IL-1β), collectively foster a bone marrow microenvironment that promotes osteoclast activity and inhibits osteoblast function. This accelerates bone loss and the deterioration of bone microstructure, thereby significantly increasing the risk of OVCF occurrence.Following fracture, the dysregulated immune response further leads to an excessive or protracted initial inflammatory phase. This disrupts the subsequent, precisely orchestrated repair stages, including soft callus formation and bone remodeling, potentially resulting in delayed union or even non-union. Based on this understanding, this article proposes novel strategies such as establishing an integrated "immune-bone" assessment system, targeted modulation of inflammatory responses, optimization of nutritional and exercise interventions, and exploration of immunocellular therapies. The aim is to reshape the immune microenvironment to one that is conducive to bone repair through multidimensional interventions.The conclusion further outlines the prospective integration of precision medicine principles, anticipating the broad potential for future development of biologics targeting specific immune pathways and personalized treatment regimens. This perspective aims to provide innovative strategies and theoretical foundations that extend beyond the scope of traditional orthopedics for the prevention and management of OVCF in the elderly.

Zhonghao Li, Jianyu Zou. The Role of Immune-Bone Interactions in the Pathogenesis and Healing of Osteoporotic Vertebral Compression Fractures in the Elderly. Frontiers in Medical Science Research (2026), Vol. 8, Issue 1: 79-87. https://doi.org/10.25236/FMSR.2026.080109.

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