[Neuromodulation in bone homeostasis and injury repair]

Bone homeostasis essentially represents a balanced interplay among bone cells, dynamically maintaining bone mass and structural stability under the influence of both internal and external factors of the body. Bone tissue receives various types of neural innervation and, through the secretion of signaling factors, influences the function of bone cells, collectively forming the core framework of the "neuro-skeletal axis". This review systematically analyzes the roles of multiple neural regulatory mechanisms in the maintenance of bone homeostasis and the repair of bone injuries, as well as their translational applications. The autonomic nervous system mainly regulates immune niches and maintains the dynamic balance between osteogenesis and osteoclastogenesis by coordinating sympathetic and parasympathetic nerve tones. Sensory nerves promote bone regeneration through neuropeptides and mechanosignal coupling. The central nervous system further integrates peripheral signals and exerts feedback regulation on bone metabolism through multiple pathways. Although approaches such as receptor blockers, neural magnetic stimulation, and bioengineered scaffolds have gradually shown clinical application potential, their safety, efficacy, and underlying mechanisms still require further investigation. Future research should focus on multidisciplinary efforts to develop precise and controllable neural modulation strategies, providing novel cross-scale interventions for diseases such as osteoporosis and fractures.