Research Progress on Traditional Chinese Medicine Treatment for Osteoporosis Based on Gut Microbiota Regulation

Abstract

Osteoporosis is a systemic bone metabolic disorder caused by an imbalance between bone formation and resorption. Research has shown that dysbiosis of the gut microbiota is closely associated with its onset and progression, involving multi-pathway regulation involving the nervous, endocrine, immune, and oxidative stress systems. In calcium metabolism regulation, dysfunction of this axis reduces intestinal calcium absorption and renal calcium reabsorption, while also disrupting the regulatory functions of parathyroid hormone and vitamin D, leading to calcium transport imbalance. In terms of immune regulation, abnormal activation of the brain-gut-bone axis promotes Th17 cell differentiation and inhibits Treg function, leading to excessive secretion of pro-inflammatory factors such as IL-17 and TNF-α, which stimulate osteoclast maturation and enhanced bone resorption activity. The gut microbiota regulates the endocrine system through metabolic products such as short-chain fatty acids, particularly affecting estrogen metabolism. Dysbiosis can reduce β-glucuronidase activity, disrupting the osteoblast-osteoclast balance. At the neurotransmitter level, the gut microbiota regulates serotonin synthesis through tryptophan metabolism, acting on 5-HT receptors in bone tissue to regulate bone metabolism while also influencing the central nervous system. It modulates antioxidant enzymes to mitigate oxidative stress-induced damage to osteoblasts, maintaining redox balance in the bone microenvironment, thereby forming a microbiota-bone metabolism regulatory network. Traditional Chinese medicine has made significant progress in this field. This paper systematically elucidates the mechanisms by which single herbal components such as strychnos glycosides and oleanolic acid, as well as compound formulations like ginseng bone granules and turmeric bone-strengthening pills, improve osteoporosis by regulating the gut microbiota microecology. The aim is to provide theoretical basis for clinical drug development targeting osteoporosis (OP).