Overview of Osteoporosis and Rotator Cuff Disease

Background: Rotator cuff disease and osteoporosis are frequently overlapping pathologies in the older patient population. Increasing evidence suggests that impaired bone health negatively impacts rotator cuff tear development and healing after repair. Methods: An online search of PubMed and MEDLINE was performed from inception to April 2026, using the keywords "osteoporosis" and "rotator cuff". Thirty-two studies met all criteria. These studies summarize the current literature on the relationship between osteoporosis and rotator cuff disease, with an emphasis on epidemiology, evaluation, treatment implications, and future directions. Results: Osteoporosis is associated with rotator cuff tear development, poorer local bone quality, and impaired tendon-to-bone healing following repair. Chronic rotator cuff pathology may also contribute to localized osteopenia of the greater tuberosity, suggesting a bidirectional relationship between bone loss and rotator cuff degeneration. Despite this overlap, osteoporosis remains under-recognized and under-treated in patients with rotator cuff disease. Vitamin D status, bone health assessment, and emerging bone-active therapies have demonstrated improved outcomes. Conclusions: Osteoporosis is an important comorbidity to consider in patients with rotator cuff disease. Improved recognition and optimization of bone health may enhance both skeletal and shoulder-specific outcomes. Further prospective studies are needed to better define optimal management strategies.