Osteoporosis （OP） is a metabolic disorder characterized by microstructural deterioration of bone and increased bone fragility due to reduced bone mass， which can cause the development of bone-related diseases. This condition imposes significant economic and psychological burdens on patients. While modern medicine has extensively researched the pathogenesis of OP， it remains incompletely understood. Current clinical management primarily relies on anti-resorptive drugs and synthetic metabolic agents. However， long-term use of some medications may yield suboptimal therapeutic outcomes and lead to severe adverse reactions. Given the necessity for prolonged or lifelong treatment for OP， there is a critical need to identify highly effective， safe， and cost-effective pharmaceutical interventions. In light of evolving disease management paradigms and recent advancements in OP research， traditional Chinese medicine has demonstrated emerging advantages in addressing this condition. Through literature review， this study delves into the pathogenesis of OP from five perspectives： hormonal dysregulation， autophagy， ferroptosis， oxidative stress， and intestinal flora alteration. Furthermore， it summarizes the therapeutic efficacy and specific mechanisms of traditional Chinese medicine monomers and compound formulas against OP through regulating hormone levels， interfering with autophagy， inhibiting ferroptosis， counteract oxidative stress，and maintain intestinal flora balance. These multifaceted insights are expected to provide theoretical reference and guide future clinical traditional Chinese medicine approaches for preventing and managing OP.

To explore the effects of miR-21 on macrophage autophagy, proliferation and apoptosis induced by cigarette smoke extract (CSE).
 Methods: The cells was divided into a control group, a CSE interventine macrophage group (CSE group), and a miR-21 inhibitor+CSE intervention macrophage group (miR-21 inhibitor+CSE group). The expression of miR-21 in the 3 groups was detected by real-time PCR. The effects of miR-21 inhibitor on macrophage autophagy, proliferation and apoptosis were detected by Western blot, MTT assay and flow cytometry.
 Results: Compared with the control group, the levels of miR-21 and autophagy in the CSE group were significantly increased (both P<0.05). The expression of miR-21 in the miR-21 inhibitor+CSE group was significantly lower than that in the CSE group (P<0.05). Compared with the control group, the expressions of macrophage microtubule associated protein 1 light chain 3 alpha (LC3) and autophagy related 7 (ATG7) in the CSE group were increased, which was attenuated by miR-21 inhibitor. Compared with the control group, the macrophage proliferation in the CSE group was inhibited by the miR-21, which could be reversed by adding miR-21 inhibitor; the proliferative rates in the miR-21 inhibitor+CSE group in 2, 3 or 4 days were increased by 1.41, 1.54 or 1.70 times compared with those in the CSE group (all P<0.05). Flow cytometry showed that the apoptosis rate in the control group was (2.57+1.35)%, which was (18.70+2.16)% in the CSE group and (6.28+1.08)% in the miR-21 inhibitor+CSE group (P<0.05).
 Conclusion: CSE intervention macrophage increase the autophagy and apoptosis of macrophages, decrease the cell proliferation by affecting the expression of miR-21 and the level of autophagy in macrophages.
Apoptosis ; drug effects ; Autophagy ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Gene Expression Regulation ; drug effects ; Macrophages ; drug effects ; MicroRNAs ; pharmacology ; Smoke