Core Viewpoint - The study highlights the role of senescent macrophages in inducing ferroptosis in skeletal muscle, which accelerates muscle atrophy related to osteoarthritis (OA) [3][8][10]. Group 1: Osteoarthritis and Muscle Atrophy - Osteoarthritis (OA) is characterized by pathological changes including cartilage damage, subchondral bone remodeling, and synovial inflammation, with muscle atrophy being a common manifestation [2]. - Muscle atrophy associated with OA is strongly correlated with knee joint symptoms and the deterioration of joint pathology [2]. Group 2: Mechanisms of Muscle Atrophy - Senescent macrophages induce ferroptosis in skeletal muscle, leading to quadriceps atrophy associated with OA [3][8]. - The mechanism involves iron overload in senescent macrophages causing mitochondrial damage in muscle cells, which reduces aspartate metabolites and inhibits the mTORC1-HMGCR signaling pathway, ultimately decreasing endogenous coenzyme Q10 (CoQ10) synthesis [3][10]. Group 3: Role of CoQ10 - CoQ10 is crucial for maintaining muscle integrity and quality, with its levels positively correlating with antioxidant capacity, muscle mass, strength, and endurance in OA patients [6]. - Exogenous supplementation of CoQ10 has been shown to alleviate muscle atrophy by inhibiting ferroptosis, significantly increasing quadriceps mass and reducing pathological damage to OA joints [10].