The impact of garlic and its active metabolites on degenerative musculoskeletal diseases.

With the accelerating global population aging, the incidence of degenerative musculoskeletal diseases (such as osteoarthritis, osteoporosis, intervertebral disc degeneration and sarcopenia) continues to rise, posing a significant public health challenge. Current conventional therapeutic approaches, while alleviating symptoms, are often accompanied by side effects and struggle to reverse the pathological process. Garlic and its various active metabolites (such as allicin, S-allylmercaptocysteine, diallyl sulfide and diallyl disulfide, etc.) have been confirmed to possess multiple biological activities, including anti-inflammatory, antioxidant effects, regulation of signaling pathways, and maintenance of extracellular matrix homeostasis. Numerous studies have demonstrated that the active metabolites of garlic can intervene in degenerative musculoskeletal diseases by regulating multiple signaling pathways such as PI3K/Akt/NF-κB, RANKL/RANK/OPG, Wnt/β-catenin, and Akt/mTOR, significantly delaying the progression of the diseases. Therefore, this review summarizes the regulatory effects and potential mechanisms of garlic and its bioactive metabolites on degenerative musculoskeletal diseases, aiming to provide a scientific basis for the further development of adjunctive therapeutic strategies based on garlic active metabolites.