Endocrine Regulation of Osteoporosis: Insights from the Brain-Bone Axis Theory

Osteoporosis (OP) is a systemic skeletal disease characterized by reduced bone mass and increased risk of fractures, with limitations in traditional treatment methods. The "brainbone axis" theory has revealed a bidirectional regulatory network between the central nervous system and the skeletal system, providing new insights into the mechanisms and treatment of OP. This review summarizes the bidirectional regulatory mechanisms of the "brain-bone axis", including descending pathways (such as the regulation of bone metabolism by the sympathetic nervous system, parasympathetic nervous system, and hypothalamic nuclei) and ascending feedback (such as bone-derived factors influencing central nervous system function through the blood-brain barrier), and explores the synergistic roles of endocrine systems (such as the thyroid axis and gonadal axis) within this network. Additionally, the article summarizes multi-modal treatment strategies based on the "brain-bone axis" theory, offering new insights for the precise prevention and treatment of OP. Future research should further integrate basic and clinical studies to advance the paradigm shift of OP from a localized bone disorder to a systemic disease.