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August 17, 2025Open Access

Role and mechanism of botanical drugs and their metabolites in osteoporosis: new strategies for clinical application

Key Points

Botanical drugs may provide safer alternatives for managing osteoporosis, addressing safety concerns associated with current pharmaceuticals.
Key traditional botanical agents like astragalus polysaccharides and glycyrrhizin offer promising prospects for clinical applications.
Review findings elucidate pathogenic mechanisms of osteoporosis, including estrogen deficiency and oxidative stress, crucial for treatment strategies.
Further research on botanical derivatives is essential for clinical translation and to improve patient outcomes in osteoporosis management.

Abstract

Osteoporosis, the most prevalent bone disease worldwide, is characterized by reduced bone mineral density and microarchitectural deterioration. Current pharmacological agents for osteoporosis management include bisphosphonates, calcitonin, estrogen, denosumab, and romosozumab. However, emerging evidence suggests these therapies may increase risks of breast cancer, ovarian cancer, osteonecrosis, and cardiovascular diseases. Consequently, safer therapeutic alternatives are required. Traditional botanical drugs, recognized for their favorable safety profiles compared to synthetic drugs, demonstrate increasing potential in osteoporosis treatment. This review examines classical pathogenic mechanisms of osteoporosis—including estrogen deficiency, oxidative stress, and dysregulated bone metabolism—and summarizes traditional botanical drugs: Astragalus polysaccharides (APS), glycyrrhizin, Cistanche deserticola polysaccharides (CDP), Eucommia ulmoides polysaccharides (EUP), and Ligustrum lucidum derivatives. These findings provide critical insights into osteoporosis pathomechanisms and identify promising therapeutic candidates for clinical translation.

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