To investigate the role of lipid metabolism abnormalities in the progression of osteoporosis (OP), clarify the impact of the key regulator angiopoietin-like protein 4 (ANGPTL4) on the adipogenic–osteogenic differentiation balance of bone marrow mesenchymal stem cells (BMSCs), and provide new insights into the molecular mechanisms and targeted therapy of OP, single-cell and multi-omics transcriptomic datasets were integrated with lipid metabolism–related gene sets. Potential key genes were identified through AUCell scoring, enrichment analysis, and machine learning algorithms validated by 5-fold cross-validation. CellChat was applied to analyze intercellular communication, while GSVA revealed associated signaling pathways. Furthermore, functional validation was performed by knocking down ANGPTL4 in BMSCs using two independent siRNA sequences. The effects on differentiation were assessed by lipid accumulation and osteogenic mineralization assays, biochemical assays, recombinant protein rescue experiments, time-course Western blot, and qPCR analysis of clinical bone marrow samples. Analysis revealed that OP-BMSCs exhibited significantly enhanced lipid metabolism activity. ANGPTL4 was identified as a core candidate gene, demonstrating robust discriminative power with a mean AUC of 0.777 in 5-fold cross-validation. Functional assays confirmed that ANGPTL4 knockdown significantly inhibited adipogenesis while enhancing osteogenic differentiation independent of cell proliferation. Importantly, treatment with recombinant ANGPTL4 protein effectively reversed these phenotypic changes. Mechanistically, ANGPTL4 silencing specifically upregulated BMP2, BMP4, and BMPR1A, leading to the activation of p-Smad1/5/9 and the accelerated expression of Runx2 and Ocn in a time-dependent manner. Consistent with these findings, ANGPTL4 mRNA levels were significantly elevated in bone marrow samples from OP patients. In conclusion, ANGPTL4 serves as a critical checkpoint connecting lipid metabolism and OP pathology. It inhibits osteogenesis by suppressing the BMP2/4-BMPR1A-Smad signaling axis. Targeting ANGPTL4 effectively restores the adipo-osteogenic balance of BMSCs, suggesting it is a promising candidate target for OP therapy, pending further in vivo validation.
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