Postmenopausal osteoporosis (PMOP) results from a combination of multiple pathological mechanisms, including osteogenic impairment and osteoclast activation triggered by estrogen deficiency-induced chronic low-grade inflammation and mitochondrial dysfunction, as well as systemic inflammation and metabolic dysregulation caused by gut microbiota imbalance. Faced with this intricate and multidimensional pathological network, conventional single-target therapeutic strategies exhibit obvious limitations. Traditional Chinese medicine (TCM), with its theoretical advantages of “holistic view” and “syndrome differentiation-based treatment,” demonstrates potential for systematic intervention through multi-target and multi-pathway coordinated regulation. Current studies indicate that various TCM formulas and active components can effectively restore the homeostasis of the bone-immune microenvironment and balance between gut microbiota and bone metabolism by comprehensively modulating these multidimensional pathological networks. Based on this, this review systematically summarizes the multidimensional mechanisms of PMOP, highlighting the multi-target regulatory effects of TCM within this pathological network, thereby providing theoretical support and research ideas for in-depth elucidation of PMOP pathogenesis and for advancing integrated prevention and treatment strategies combining TCM and western medicine.

postmenopausal osteoporosis  /  immune-inflammation  /  mitochondrial dysfunction  /  gut microbiota  /  traditional Chinese medicine