Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disease characterized by progressive ectopic bone formation process, which can lead to severe neurological impairments and reduced quality of life. While the etiology of OPLL is generally considered multifactorial, there is no consensus regarding these contributing factors including genetic, endocrine, biomechanical, immune and lifestyle factors. Through accumulating evidence from multidisciplinary investigations, the pathophysiological connection between OPLL and endocrine-metabolic dysregulation is becoming increasingly clear. Nevertheless, comprehensive understanding of the relationship between the two is hindered by several problems, such as methodological limitations and inadequate mechanistic studies. This review takes a deep dive into the possible factors contributing to OPLL from all aspects of metabolism, including glucose metabolism, lipid metabolism, bone and mineral metabolism, leptin, vitamin, growth hormone/IGF-1 and sex hormones, highlighting their potential roles in the onset and progression of OPLL. Clarifying the etiology of OPLL and elucidating the underlying pathogenesis are crucial for advancing both early intervention strategies and therapeutic approaches in clinical management. Therefore, the endocrine and metabolic disorders in OPLL patients should become a focus of future research.