[Role of bidirectional interaction between TCM and gut microbiota in treatment of osteoporosis]

With the progressive aging of the population in China, the incidence of osteoporosis(OP) is rising annually. This condition not only severely impacts patients' quality of life but also imposes a substantial economic burden on both families and the society. Although modern western medicine has achieved progress in inhibiting OP progression and alleviating associated clinical symptoms, its overall therapeutic efficacy remains suboptimal due to issues such as adverse drug reactions and patient tolerance. Consequently, developing efficient, safe, and cost-effective prevention and treatment strategies has become an urgent priority in current OP-related clinical and scientific research. In recent years, growing insights into the microbiome have revealed that the gut microbiota can regulate bone quantity and quality through multiple mechanisms, including immune modulation, calcium and phosphorus absorption, and the production of short-chain fatty acids, thereby improving the bone microenvironment. As an important component of traditional medicine, TCM is characterized by multi-component and multi-target effects, with therapeutic advantages in holistic regulation. Studies have shown that TCM can effectively improve bone mineral density, inhibit bone resorption, and promote bone formation, with a low incidence of adverse reactions and mild pharmacological effects, demonstrating its unique clinical value in the prevention and treatment of OP. Simultaneously, complex interactions exist between TCM and the gut microbiota. On the one hand, the active components of TCM can modulate the composition and structure of the gut microbiota, reduce systemic inflammation, and ultimately improve bone metabolism. On the other hand, the gut microbiota can metabolize and transform the active components of TCM, enhancing their bioavailability and promoting therapeutic efficacy. This article systematically reviews the roles of gut microbiota and TCM in OP, as well as the bidirectional interaction between TCM and gut microbiota in the prevention and treatment of OP, aiming to provide new insights and evidence for the clinical management of OP.