Herbal Therapeutics in Osteoporosis: Mechanisms, Evidence, and Translational Potential

Osteoporosis is a chronic bone disease marked by reduced density and increased fracture risk. Current treatments face limitations in safety, efficacy, and long-term adherence, prompting interest in alternative therapies. Herbal medicine, with its bioactive compounds and historical use, offers potential for bone health support. This review explores the role of Chrysanthemum morifolium, Crocus sativus, Eriobotrya japonica, Ficus carica, Glycine max, Olea europaea, Salvia rosmarinus, and Zingiber officinale in preventing and managing osteoporosis. Relevant studies were identified through comprehensive searches of Google Scholar, PubMed, Scopus, and Web of Science, without time restriction up to October 2025. Included literature encompassed in vitro experiments, in vivo animal models, and clinical trials investigating herbal interventions targeting bone loss and osteoporosis-related mechanisms. The reviewed botanicals modulate key molecular pathways involved in bone remodeling, including RANKL/NFATc1, MAPKs, NF-κB, Sirt1, Nrf2, BMP/Smad, Wnt/β-catenin, and XPO5-microRNA axes. Their bioactive constituents exert antioxidant, anti-inflammatory, anti-apoptotic, anti-senescent, and hormone-modulating effects, collectively promoting osteoblast differentiation and suppressing osteoclastogenesis. Several agents, such as crocin, safranal, and ursolic acid, demonstrated dual-action profiles and favorable safety in preclinical models, with emerging evidence supporting their immunomodulatory and angiogenic roles. Herbal therapeutics offer a multi-targeted, biologically harmonious approach to osteoporosis management. This review provides a mechanistic synthesis and translational framework for future research, highlighting their potential as adjunctive therapies, especially in aging populations. Standardization, clinical validation, and interdisciplinary collaboration are essential to advance these botanicals from bench to bedside.