The chikungunya virus (CHIKV) is an alphavirus transmitted to humans mainly through the bite of infected Aedes aegypti and Aedes albopictus mosquitoes. It has recently resurfaced in various parts of the world, triggering widespread outbreaks. CHIKV infection results in chikungunya fever (CHIKF), a temporary febrile illness typically enduring for 7-10 days. Symptoms include rash, fatigue, severe polyarthralgia affecting the hands and feet, and myalgia. Chronic CHIKF, lasting more than 3 months, affects over 40% of those infected, leading to arthritic changes such as bone erosion, enthesopathies, periostitis, and persistent joint pain.

We conducted a narrative review to discuss the musculoskeletal manifestations of CHIKV infection as well as its effects on bone health and to explore current data linking CHIKV infection with osteoporosis.

We performed a comprehensive literature search including peer-reviewed publications. Patients with chronic infection develop an incapacitating arthritis that may persist for months to years and thereby impose a burden on the population in terms of disability-adjusted life years (DALY). A recent increase in outbreaks may be related to virus evolution, globalization/international travel, and climate change, thus potentially turning CHIKV into a major global health threat. Several studies have elucidated the impact of CHIKV infection on bone health and its correlation with arthritic changes. Various cellular and molecular factors contribute to bone erosion during chikungunya virus infection. In CHIKV infection and other arthritogenic alphavirus infections, inflammatory processes marked by the production of interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and interleukin-1 (IL-1), along with an elevated receptor activator of NF-kB ligand/osteoprotegerin (RANKL/OPG) ratio, promote the formation of osteoclasts from monocytic precursors. Consequently, this leads to increased

bone resorption and bone pathologies.

The literature on osteoporosis and Chikungunya fever is a promising area of research with implications for clinical practice and scientific understanding. Further research in this field has the potential to improve outcomes for individuals affected by these conditions and expand our knowledge of the relationship between viral infections and bone health.