Bidirectional Regulation of Osteogenesis and Osteoclastogenesis: Research Progress of Chinese Herbal Medicine in Treating Senile Osteoporosis

Osteoporosis (OP) is a major global public health burden, with senile osteoporosis becoming increasingly prevalent due to population aging. OP-related fractures significantly increase disability and mortality, severely reducing patients’ quality of life. Current Western medications — such as bisphosphonates and parathyroid hormone analogs — have limitations, including gastrointestinal side effects, high costs, and long-term risks such as osteonecrosis of the jaw. Chinese herbal medicine (CHM), known for its multi-target regulatory effects and relatively low toxicity, shows promising potential in the treatment of OP. CHM compounds (e.g., Jiangu Formula, Erxian Decoction) and active monomers (e.g., phaseol, glycycoumarin, icariin) have been shown to regulate bone metabolism through bidirectional modulation of osteogenesis and osteoclastogenesis. Their efficacy in improving bone mineral density (BMD) and reducing bone loss has been demonstrated in animal models and small-scale clinical trials. However, there remain gaps in large-scale, high-quality clinical evidence, and the precise mechanisms of some active components remain unclear. Future research should focus on standardizing CHM formulations and elucidating specific therapeutic targets to enhance clinical translation.