Osteoporosis (OP) is a metabolic bone disease characterized by reduced bone mass and deterioration of bone tissue microstructure. With the global aging population, the incidence of OP is progressively increasing. Current Western medical treatments primarily rely on bone-forming agents and bone resorption inhibitors, which often exhibit significant side effects and are unsuitable for long-term use. OP is a condition where traditional Chinese medicine (TCM) demonstrates therapeutic advantages, and Duzhong (Cortex Eucommiae) is a commonly used traditional Chinese herb for treating OP. This article reviewed Duzhong (Cortex Eucommiae) and its primary active components, such as pinoresinol diglucoside, aucubin and geniposidic acid, focusing on their multi-pathway regulatory mechanisms against OP. Duzhong (Cortex Eucommiae) and its components promote bone formation by modulating the Wnt/β-catenin and bone morphogenetic protein (BMP) /Smad signaling pathways, while inhibiting bone resorption through the mitogen activated protein kinase (MAPK) and osteoprotegerin (OPG) /receptor activator of nuclear factor-κB ligand (RANKL) /nuclear factor-κB receptor activating factor receptor (RANK) signaling pathways. Additionally, they regulate the coupling of bone formation and resorption by influencing the phosphoinositide 3-kinase (PI3K) /protein kinase B (AKT) and estrogen signaling pathways. Furthermore, Duzhong (Cortex Eucommiae) and its components can regulate bone angiogenesis by stimulating the expression of vascular factors in bone marrow mesenchymal stem cells via the BMP/Smad pathway or by modulating the secretion of platelet-derived growth factor in osteoclast precursor cells through the mitogenactivated protein kinase (MAPK) /nuclear factor kappa-B (NF-κB) pathway. Moreover, Duzhong (Cortex Eucommiae) and its components can modulate the polarization state of macrophages, alter the expression of inflammatory factors and improve the bone immune-inflammatory microenvironment, thereby maintaining bone homeostasis. In summary, Duzhong (Cortex Eucommiae) exerts anti-OP effects through multiple mechanisms and pathways, providing valuable insights and references for its clinical application and development.