Traditional Chinese Medicine for osteoporosis management: from molecular mechanisms to drug discovery

Osteoporosis, a prevalent skeletal disorder, poses significant challenges in aging populations. Traditional Chinese Medicine (TCM) offers a multi-target approach to addressing its complex pathogenesis, which involves hormonal imbalance, oxidative stress, and inflammation. This review highlights the current progress in osteoporosis, focusing on the molecular mechanisms and therapeutic targets of relevant mechanisms, as well as the related cellular events and signaling pathways. Furthermore, the study reviews the clinical effectiveness of several representative TCM formulae, such as Xianling Gubao Capsule and Qing'e pill, which can reduce fracture risk by promoting bone formation and suppressing bone resorption. The study also discusses the therapeutic principles of the promising medicinal herbal compounds, such as icariin for enhancing osteogenesis, naringin for inhibiting osteoclastogenesis, and astragaloside IV for reducing cellular senescence. In summary, TCM's holistic approach offers a valuable strategy for managing osteoporosis, particularly for high-risk patients. Integrating traditional knowledge with modern science enables the development of safer, multi-target therapies addressing both bone quantity and quality. Continued research will facilitate evidence-based TCM interventions for global osteoporosis care.