Advances in Osteoporosis: Pathophysiology, therapies and herbal insights

Osteoporosis is a progressive skeletal disorder marked by reduced bone density and compromised bone microarchitecture, ultimately increasing fracture risk. It progresses silently until fractures occur, particularly in postmenopausal women and older adults, owing to hormonal imbalance and accelerated bone turnover. The disease originates from dys-regulated bone remodeling in which osteoclastic resorption surpasses osteoblastic formation. Contributing factors such as genetics, nutritional deficiencies, sedentary lifestyle, and chronic illnesses further exacerbate its development. Over the decades, osteoporosis management has evolved from nutritional supplementation and hormonal therapy to targeted pharmacological interventions that modulate pathways like RANK/RANKL, Wnt/β-catenin, and PTH signaling. Contemporary therapies involve anabolic agents, monoclonal antibodies, and personalized sequential regimens designed to enhance skeletal strength while minimizing adverse effects. Traditional herbs from regions such as Chhattisgarh provide valuable complementary benefits due to their rich phytochemical composition, which supports osteoblast activity, mitigates oxidative stress, and reduces osteoclastogenesis. These botanicals hold potential for integration into modern therapeutic frameworks and future drug development. An integrative approach combining advanced pharmacotherapy, preventive strategies, and evidence-based herbal support offers a comprehensive path toward sustained bone health. Continued research is essential to validate herbal efficacy, refine molecular therapies, and develop optimized treatment algorithms.