Currently, medications for treating osteoporosis are primarily categorized into two groups: those that stimulate bone formation and those that suppress bone resorption. Nevertheless, these medications are accompanied by side effects, including stroke, cardiovascular issues, gastrointestinal discomfort, and kidney damage. Consequently, there is a hope for the development of more effective and safer anti-osteoporosis drugs to offer a broader range of options for clinical treatment. We have conducted a comprehensive review of the research on the regulation of bone mass by Polygonatum sibiricum polysaccharides and have concluded that these polysaccharides represent a natural bone mass regulator with significant potential for further development. They primarily exert their effects by promoting the differentiation of bone marrow mesenchymal stem cells into osteoblasts, inhibiting osteoclast activity, regulating estrogen receptor-related endocrine functions, bone immunity, antioxidant properties, and inflammatory damage, as well as modulating the intestinal microbiota. In the process of balancing osteogenesis and osteoclastogenesis, multiple cellular signaling pathways are implicated, such as Wnt/β-catenin, BMP/Smad, PI3K/AKT/mTOR, OPG/RANKL/RANK, and Hippo. It is evident that Polygonatum sibiricum polysaccharides exert their effects on bone mass regulation through multiple targets and intricate mechanisms. In the process of extracting and applying Polygonatum sibiricum polysaccharides as agents for bone mass regulation, a variety of extraction techniques are available for use. The predominant methods encompass: high-strength extraction coupled with alcohol precipitation, ultrasonic-assisted extraction, ultrasonic-assisted enzymatic extraction, microbial mineralization extraction, and ultra-high pressure extraction. These studies have advanced the development of Polygonatum sibiricum as a natural product for the purpose of bone mass regulation. Graphical abstract • P. sibiricum polysaccharide (PSP) shows potent anti-osteoporosis effects and high safety. • PSP regulates bone metabolic balance via multiple targets, promoting osteogenesis and inhibiting osteoclast activity. • PSP resists osteoporosis through multi-dimensional mechanisms: endocrine, immune, antioxidant and gut microbiota regulation. • Optimized PSP extraction enables industrialization; further research will boost its clinical translation for osteoporosis.
Jiang et al. (Sun,) studied this question.