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Cellular senescence and the skeleton: pathophysiology and therapeutic implications
Sundeep Khosla, Joshua N. Farr, David G. Monroe
Sundeep Khosla, Joshua N. Farr, David G. Monroe
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Cellular senescence and the skeleton: pathophysiology and therapeutic implications

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Abstract

Cellular senescence is a fundamental aging mechanism that is currently the focus of considerable interest as a pathway that could be targeted to ameliorate aging across multiple tissues, including the skeleton. There is now substantial evidence that senescent cells accumulate in the bone microenvironment with aging and that targeting these cells prevents age-related bone loss, at least in mice. Cellular senescence also plays important roles in mediating the skeletal fragility associated with diabetes mellitus, radiation, and chemotherapy. As such, there are ongoing efforts to develop “senolytic” drugs that kill senescent cells by targeting key survival mechanisms in these cells without affecting normal cells. Because senescent cells accumulate across tissues with aging, senolytics offer the attractive possibility of treating multiple age-related comorbidities simultaneously.

Authors

Sundeep Khosla, Joshua N. Farr, David G. Monroe

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Figure 2

Working model of the senescence pathway based on a large number of in vitro and animal studies.

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Working model of the senescence pathway based on a large number of in vi...
The top box lists cellular stressors that trigger activation of key senescence inducers (p16Ink4a/Rb and p21Cip1/p53). This leads to activation of senescence mediators, which, in turn, promote the secretion of the proinflammatory SASP, resulting in tissue dysfunction. Senescent cells also activate senescent cell antiapoptotic pathways (SCAPs) that are the target of “senolytic” drugs. By contrast, “senomorphic” drugs do not kill senescent cells but rather inhibit the production and/or secretion of the SASP.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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