The ultimate microbial composition for correcting Th17/Treg cell imbalance and lipid metabolism disorders in osteoporosis

•The intestinal microorganisms disorders may be key inducers of osteoporosis.•The intestinal microorganisms disorders may induce osteoporosis by influencing immune function and lipid metabolism.•This review demonstrated that Th17 cells promote bone resorption by promoting osteoclast differentiation, whereas Treg cells inhibit bone resorption by inhibiting osteoclast differentiation and promoting osteoblast formation. Furthermore, PPAR-γ, Wnt, and IGF-1 signalling pathways play an important role in regulating lipid disorders in osteoporosis. Therefore, Treg/Th17 imbalance and lipid disorders are the key to the osteoporosis pathogenesis. This review elucidates that intestinal microorganisms can correct osteoporosis Th17/Treg imbalance and lipid disorders to exert curative effects. Finally, this review elaborates on the therapeutic mechanisms of intestinal microorganism-targeted probiotics, prebiotics, diet, and feacal micrograft transplantation (FMT) for osteoporosis. Osteoporosis is a systemic bone disease characterised by decreased bone mass and a deteriorated bone microstructure, leading to increased bone fragility and fracture risk. Disorders of the intestinal microbiota may be key inducers of osteoporosis. Furthermore, such disorders may contribute to osteoporosis by influencing immune function and lipid metabolism. Therefore, in this review, we aimed to summarise the molecular mechanisms through which the intestinal microbiota affect the onset and development of osteoporosis by regulating Th17/Treg imbalance and lipid metabolism disorders. We also discussed the regulatory mechanisms underlying the effect of intestinal microbiota-related modulators on Th17/Treg imbalance and lipid metabolism disorders in osteoporosis, to explore new molecular targets for its treatment and provide a theoretical basis for clinical management.