The therapeutic potential of descending regulatory pathways from brain to bone in osteoporosis: focusing on the brain-bone axis

Osteoporosis (OP) is a growing global health concern, characterized by reduced bone mass, deterioration of bone microarchitecture, and consequently increased bone fragility. The brain-bone axis, a complex regulatory network encompassing the nervous, endocrine, and immune systems, elucidates the central role of the brain in regulating bone homeostasis. Consequently, this axis has become a major focus of interdisciplinary research into the pathogenesis of OP. However, the current understanding of the descending regulatory pathways from the brain to the bone remains incomplete. Therefore, this paper preliminarily explores the mechanisms and experimental evidence of different descending regulatory pathways from a new perspective. It integrates multiple descending regulatory pathways, discusses some of their interrelationships, and reveals the complex network nature of central bone metabolism regulation. Our objective is to elucidate the role of the central nervous system (CNS) in OP pathogenesis, thereby offering new insights and directions for future research on its prevention and treatment.