Multi-System Mechanisms in the Anti-Osteoporotic Effects of Herbal Natural Products

INTRODUCTION: Osteoporosis(OP) is increasingly recognized as a multi-system disorder beyond traditional hormonal and nutritional perspectives. This review aims to systematically present the therapeutic potential of natural components from Chinese medicine and herbal formulae, clarifying their mechanisms of action within human physiological systems. METHODS: We conducted a comprehensive search of relevant studies in PubMed, Web of Science, CNKI, and other databases. The focus was on the use of herbal monomers and classical formulas in the field of OP. This analysis focused on their multisystem interactions and their potential molecular pathways. RESULTS: Our analyses indicate that these natural products not only directly regulate bone metabolism through the Wnt/β-catenin, BMP/Smad, OPG/RANK/RANKL, and PI3K/AKT pathways, but they also exert anti-osteoporotic effects through multi-system regulatory mechanisms. Specifically, they exert therapeutic effects by: alleviating endocrine imbalances through regulating parathyroid hormone and estrogen levels; alleviating chronic inflammation via the NF-κB and MAPK pathways; regulating the composition of intestinal flora; and affecting nervous system signalling via sympathetic modulation. The herbal formulae particularly show synergistic effects when acting on multiple systems at the same time. DISCUSSION: The synthesis of evidence reveals that TCM counteracts OP via a holistic, system-restorative mechanism. By concurrently modulating endocrine, inflammatory, intestinal, and neural functions, this multi-system strategy addresses the complex etiology of OP and presents a complementary paradigm to conventional target therapies. CONCLUSION: Chinese medicine offers a multi-targeted treatment option for OP through restoring balance to the physiological system. This holistic treatment strategy, derived from TCM theory and increasingly validated by modern research, offers a promising complementary therapy for the treatment of OP. It can complement traditional single-targeted therapies.