Credit: Bone Research (2025). Two: 10.1038/S41413-025-00450-Z
Scientists have found a direct link between osteoporosis and rotator cuff tears, two conditions that often develop with age. Using health and genetic data from hundreds of thousands of people, researchers showed that fragile bones increase the risk of painful shoulder injuries, especially in women. They also identified shared genetic variants, offering fresh insight into the biological ties between bone and tendon weakness and pointing toward targeted prevention and treatment strategies.
Rotator cuff tears (RCTs) are one of the most common causes of shoulder pain and disability, affecting nearly 1 in 3 people over the age of 60. They often lead to long-lasting pain, loss of arm strength, and difficulty with daily tasks. Despite their prevalence, the underlying risk factors behind these shoulder injuries have not been fully understood.
A new study, published in the journal Bone Researchhas now uncovered a strong connection between osteoporosis and RCTs. The study was led by Dr. Jinjin Ma and Dr. Hongmin Cai from South China University of Technology in Guangdong, China, along with Dr. Xiaofei Zheng from Jinan University, China.
Osteoporosis is a widespread condition in which bones gradually lose strength and density, making them more fragile and prone to fractures. By analyzing health and genetic data from the UK Biobank—a resource that tracks the health of over half a million people—researchers found not only that osteoporosis raises the risk of RCTs but also that the two conditions share common genetic roots.
Dr. Ma explains, “Our results provide strong evidence that osteoporosis significantly increases the risk of rotator cuff tears. This suggests that managing bone health could also play a critical role in preventing these painful shoulder injuries.”
To explore the connection, the research team examined health records from nearly 458,000 people and then tracked more than 268,000 of them for 11 years. They used advanced statistical and computer-based methods to rule out other possible explanations, such as age, sex, or lifestyle. This allowed them to move beyond showing a simple link and instead suggest that osteoporosis itself may directly increase the risk of RCTs.
The findings were striking. Individuals with osteoporosis were 1.56 times more likely to suffer an RCT than those without the condition. The risk was particularly pronounced among women, highlighting how hormonal changes—especially the sharp decline in estrogen after menopause—may accelerate both bone loss and tendon damage.
“The sex differences we observed suggest that women may require special monitoring and earlier interventions for rotator cuff health if they also have osteoporosis,” notes Dr. Cai.
The researchers also looked at whether genes might explain why the two conditions often appear together. By comparing large sets of genetic data, they discovered six points in the genome that seem to influence both osteoporosis and RCTs. Among these, one variant near the PKDCC gene stood out and was confirmed across multiple datasets. This gene is known to help regulate bone and tendon tissue, offering a possible biological explanation for the link.
The study also found that common supplements such as calcium and vitamin D did not reduce the risk of shoulder injuries. This suggests that stronger osteoporosis treatments—such as certain prescription drugs or hormone therapies—may hold greater promise, though further research is needed.
RCTs are already a growing public health concern, with nearly a quarter of surgical repairs failing within two years. Combined with the high global burden of osteoporosis—affecting more than 200 million people—the link between the two conditions highlights an urgent need for preventive strategies.
Dr. Zheng emphasizes, “Our study suggests that preventing or treating osteoporosis may also reduce the likelihood of rotator cuff tears. This dual benefit could improve quality of life for millions of aging individuals worldwide.”
Although this extensive study offers valuable insights, the authors emphasize the need for further research. It only considered individuals with diagnosed tears, leaving silent, undiagnosed cases unexamined. Additionally, the exact mechanisms linking osteoporosis to tendon weakness require validation through further laboratory studies.
The findings signify a key advancement in musculoskeletal research. By combining extensive population data, modern analysis, and genetic insights, the team has shown that brittle bones and torn shoulders are more closely related than previously understood.
“These findings remind us that bone and tendon health are deeply interconnected. By recognizing and addressing this relationship, we may be able to develop new strategies to protect both, ensuring healthier and more active lives as people age,” concludes Dr. Ma.
More information:
Yibin Liu et al, Association between osteoporosis and rotator cuff tears: evidence from causal inference and colocalization analyses, Bone Research (2025). Two: 10.1038/S41413-025-00450-Z
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What specific genes have been identified as influencing both bone mineral density and rotator cuff tear susceptibility?
Table of Contents
- 1. What specific genes have been identified as influencing both bone mineral density and rotator cuff tear susceptibility?
- 2. Genetic Links Uncover Connection Between Osteoporosis and Rotator Cuff Tears
- 3. The Emerging relationship: bone Density & Shoulder Health
- 4. Genetic Factors at Play: Identifying Shared Risk
- 5. How Osteoporosis Increases Rotator Cuff Tear Risk
- 6. Diagnosing the Connection: What to Look For
- 7. Benefits of Addressing Both Conditions Concurrently
- 8. Practical Tips for Prevention & Management
Genetic Links Uncover Connection Between Osteoporosis and Rotator Cuff Tears
The Emerging relationship: bone Density & Shoulder Health
For years, rotator cuff tears were largely attributed to acute injuries or age-related degeneration. However, a growing body of research highlights a meaningful, often overlooked, connection: osteoporosis. This isn’t simply a correlation; emerging evidence points to shared genetic predispositions and underlying biological mechanisms linking weakened bones and increased risk of shoulder injuries, specifically rotator cuff tears. Understanding this connection is crucial for preventative care and improved treatment outcomes. We’re seeing a shift in how we approach shoulder pain management, moving beyond solely focusing on the muscles and tendons.
Recent genome-wide association studies (GWAS) are beginning to pinpoint specific genes that influence both bone mineral density (BMD) and rotator cuff tear susceptibility.
* Vitamin D Receptor (VDR) gene: Variations in this gene are linked to both lower BMD and increased risk of tendon degeneration. Vitamin D plays a vital role in calcium absorption, essential for bone health, and also impacts tendon strength.
* Collagen Type I alpha 1 (COL1A1) gene: This gene provides instructions for making a protein that is a major component of bone and tendons. Mutations can lead to osteogenesis imperfecta (brittle bone disease) and also contribute to weaker tendons, predisposing individuals to tears.
* Estrogen Receptor Alpha (ESR1) gene: Estrogen is protective of bone density. Variations impacting estrogen receptor function can increase osteoporosis risk and potentially affect tendon health.
These aren’t isolated findings. Researchers are discovering that genes influencing bone metabolism often have pleiotropic effects – meaning they influence multiple traits – including tendon structure and function. This suggests a systemic vulnerability rather than localized issues. Rotator cuff disease and osteoporotic fractures may share a common genetic pathway.
How Osteoporosis Increases Rotator Cuff Tear Risk
The link isn’t solely genetic. Osteoporosis directly impacts the shoulder joint in several ways:
- reduced Bone Quality: Osteoporosis weakens the bones surrounding the shoulder joint (humerus and scapula). This makes them more susceptible to stress fractures and impacts the attachment points for tendons.
- Altered Shoulder Mechanics: Bone loss can change the shape and alignment of the shoulder joint, increasing stress on the rotator cuff tendons.
- Impaired tendon Healing: Osteoporosis can impair the body’s ability to heal damaged tissues, including tendons. Reduced blood supply and compromised cellular function hinder the repair process.
- Increased Tendon Entrapment: Bone spurs, common in osteoporosis, can narrow the space around the rotator cuff tendons, leading to impingement and eventual tearing.
Essentially, osteoporosis creates a less stable and more vulnerable environment for the rotator cuff. Individuals with low bone density are demonstrably at higher risk.
Diagnosing the Connection: What to Look For
Early detection is key. If you’re experiencing chronic shoulder pain, especially if you have risk factors for osteoporosis (age, family history, certain medications), a extensive evaluation is crucial. This should include:
* Bone Density Scan (DEXA scan): To assess BMD and diagnose osteoporosis or osteopenia (low bone density).
* Shoulder MRI: To evaluate the rotator cuff tendons for tears, inflammation, and other abnormalities.
* Physical Examination: Assessing range of motion, strength, and pain levels.
* Genetic Testing (Emerging): While not yet standard practice, genetic testing may become more common to identify individuals at higher risk.
Benefits of Addressing Both Conditions Concurrently
Treating osteoporosis alongside a rotator cuff tear offers several advantages:
* Improved Healing: Strengthening bones can create a more favorable environment for tendon repair.
* Reduced Re-Tear Rates: Addressing underlying bone weakness can lower the risk of future tears.
* Pain Management: Optimizing bone health can contribute to overall pain reduction.
* Enhanced Function: Improved bone density and tendon health lead to better shoulder function and quality of life.
Practical Tips for Prevention & Management
here are actionable steps you can take:
* calcium & Vitamin D Intake: Ensure adequate intake through diet and/or supplements. Recommended daily intake varies based on age and individual needs.
* weight-Bearing Exercise: Regular exercise, such as walking, jogging, and weightlifting, stimulates bone growth.
* strength Training: Focus on exercises that strengthen the shoulder muscles and improve stability.
* Fall Prevention: Reduce your risk of falls by removing hazards in your home and wearing appropriate footwear.
* Medication Adherence: If prescribed medication for osteoporosis, take
