Bone and infections: an osteoimmunological interplay

Osteoimmunology examines the bidirectional interactions between the skeletal and immune systems, focusing on the mechanisms by which immune cells regulate bone homeostasis and how the bone microenvironment modulates immune responses. Chronic inflammation is a major driver of bone loss, and infections of bacterial or viral origin perturb bone remodeling with consequences for host defense. In infected bone tissue, immune cell infiltration and the release of cytokines and soluble mediators alter the activity of osteoclasts and osteoblasts, thereby promoting bone erosion and structural remodeling. Recent studies highlight how immune dysregulation contributes to the pathogenesis of osteomyelitis and other infection-associated bone disorders, implicating specific inflammatory pathways and cellular interactions as potential therapeutic targets. This review synthesizes current evidence on direct and indirect mechanisms by which infection affects bone, identifies gaps in mechanistic understanding, and discusses implications for diagnosis and intervention.