Healthy Longevity and Translational Medicine

Degenerative disorders of the joints and skeleton are major contributors to pain, disability, loss of mobility, and declining quality of life with advancing age. In China, osteoarthritis and degenerative spinal disorders affect large and growing populations, while low back pain remains one of the leading causes of disability worldwide.

The socioeconomic burden associated with degenerative musculoskeletal disorders is substantial. Chronic back pain and spinal degeneration generate major healthcare expenditures and contribute significantly to disability and lost productivity. Despite advances in symptom management, effective disease-modifying therapies remain limited. For patients with advanced structural disease, surgical interventions—including joint replacement and spinal fusion—may ultimately become necessary.

To date, the development of effective disease-modifying therapies for many degenerative musculoskeletal disorders has remained challenging. As populations around the world continue to age, chronic pain, impaired mobility, fatigue, and associated age-related conditions represent an increasingly important global health challenge.

With support from the World Development Foundation, Shenzhen University of Advanced Technology is convening this international symposium to foster collaboration across basic science, clinical medicine, biotechnology, industry, investment, and global health. The symposium will explore emerging mechanisms of skeletal interoception and their potential implications for the prevention and treatment of age-related musculoskeletal, neurological, and chronic pain disorders.

Chronic pain is a major clinical manifestation of age-related joint and spinal disorders and one of the most common reasons patients seek medical care. Persistent pain, including pain at rest, can substantially impair quality of life, limit physical activity, and contribute to progressive functional decline. Increasing pain severity has also been associated with greater risk of physical limitation and disability.

Chronic low back pain can profoundly affect quality of life, mobility, and daily physical activity and is associated with an increased risk of functional decline. Emerging research has identified potential links between skeletal remodeling, sensory innervation, and neurological function. Studies of osteoarthritis and low back pain have implicated osteoclast-derived netrin-1 signaling in pathological sensory nerve innervation, while other investigations have identified age-related changes in osteoclast-derived signaling factors, including PDGF-BB, in the context of cerebral small-vessel disease.

Growing evidence suggests important interactions among skeletal aging, chronic musculoskeletal pain, neurological function, and age-related neurodegenerative disorders. These emerging connections highlight the need for interdisciplinary research spanning musculoskeletal biology, neuroscience, pain medicine, and aging.

Recent research from Dr. Xu Cao and colleagues has advanced the concept of skeletal interoception—bidirectional communication between the skeletal system and the central nervous system that may contribute to the regulation of bone, cartilage, joint homeostasis, and systemic physiology. Interoception broadly refers to the nervous system’s sensing and integration of signals arising from within the body. Sometimes described as an internal or “sixth” sense, it complements exteroception—the sensory processes through which the body perceives and interacts with the external environment. Professor Belinda Beck has developed evidence-based weight-bearing exercise interventions for osteoporosis that have informed exercise guidance. Her work further highlights the value of exploring how skeletal interoceptive mechanisms may interact with mechanical loading in the prevention and management of age-related skeletal disorders. The symposium will bring together leading investigators in joint disease, pain, and brain–bone communication to discuss this emerging field and its translational potential.

Emerging studies suggest that sensory neural pathways within the skeletal system participate in bidirectional communication with the brain and may influence processes such as bone remodeling, osteogenesis, cartilage homeostasis, and tissue regeneration. Skeletal interoception therefore represents an interdisciplinary field at the intersection of bone biology, neuroscience, biomechanics, pain research, and regenerative medicine.

Within this emerging framework, the skeletal system senses changes in mechanical loading, metabolic state, injury, and tissue integrity through molecular and neural signaling pathways. These signals may be transmitted to the central nervous system, which in turn can modulate skeletal and systemic physiological responses through descending neural and neuroendocrine pathways. Age-related disruption of these signaling networks may contribute to degenerative conditions including osteoarthritis, spinal degeneration, chronic pain, and impaired mobility.

Recent experimental research also suggests potential links between skeletal sensory signaling, hypothalamic regulation, gravity sensing, and brain function. Altered mechanical loading and microgravity during spaceflight are known to produce profound changes in skeletal metabolism and other physiological systems, providing a unique model for investigating communication between the skeleton and the brain. Understanding these mechanisms may open new avenues for studying healthy aging and developing interventions for age-related musculoskeletal and neurological disorders.