Targeting the gut-bone axis through traditional Chinese medicine: Therapeutic strategies for osteoporosis prevention and treatment
Pharmacological Research - Modern Chinese Medicine · Published 2026-04-03 · DOI 10.1016/j.prmcm.2026.100811
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Abstract
Introduction: Osteoporosis, characterized by disrupted bone remodeling and increased fracture risk, represents a growing global health burden that conventional single-target therapies fail to fully address. Emerging evidence highlights gut microbiota (GM) dysbiosis as a critical pathogenic factor, wherein microbial metabolites—particularly short-chain fatty acids (SCFAs) orchestrate systemic immune responses and bone homeostasis. Traditional Chinese Medicine (TCM) offers a theoretically grounded approach through its classical ''Spleen-Kidney interdependence'' framework, which conceptualizes gut function as integral to skeletal health. However, the mechanistic pathways through which TCM formulations modulate the GM-bone axis remain insufficiently characterized. Methods: We conducted a systematic search of databases (PubMed, Embase, Scopus, Web of Science) to identify studies investigating TCM interventions targeting the gut-bone axis. Ultimately, 46 studies met the inclusion criteria. Results: TCM formulations consistently restore GM diversity, enriching SCFAs-producing taxa (Akkermansia, Lactobacillus, Bifidobacterium) while suppressing pathogenic populations. Individual medicinals and bioactive constituents exert taxon-specific effects through neuroendocrine, prebiotic, and metabolic pathways. Nano-engineered delivery systems further overcome bioavailability limitations for targeted colonic release. Conclusion: TCM operates through a ''microbiota-barrier-immune-metabolism-bone'' hierarchical network, transforming traditional ''tonifying Kidney and strengthening Spleen'' efficacy into quantifiable gut-to-bone regulatory mechanisms. This positions TCM as a systems-level alternative to conventional therapies.
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- 2026
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