This review discusses the role of lipid metabolism in the development of osteoporosis, a common bone metabolic disease that poses a significant social burden and threatens life. The study highlights the bidirectional differentiation of bone marrow mesenchymal stem cells (BM-MSCs) into osteoblasts and adipocytes, and the mutual regulation of osteogenesis and adipogenesis through peroxisome proliferator-activated receptor γ (PPARγ) and Wnt/β-catenin signaling pathways. Lipid substances, such as triglycerides, cholesterol, phospholipids, glycolipids, and bile acids, play crucial roles in bone metabolism. Excessive lipid accumulation inhibits osteogenesis, while appropriate lipid levels can improve bone mass. Inflammation and oxidative stress are key pathological changes in osteoporosis, with inflammatory factors like IL-1 and TNF-α promoting osteoclast differentiation and oxidative damage inhibiting osteogenesis. Obesity, a high-risk factor for osteoporosis, increases the risk of fracture and accelerates bone loss through the redistribution of adipose tissue and the release of inflammatory factors. The review concludes that adjusting lipid content and proportion, alleviating inflammatory storms, and reducing oxidative damage can improve bone mass and treat osteoporosis.This review discusses the role of lipid metabolism in the development of osteoporosis, a common bone metabolic disease that poses a significant social burden and threatens life. The study highlights the bidirectional differentiation of bone marrow mesenchymal stem cells (BM-MSCs) into osteoblasts and adipocytes, and the mutual regulation of osteogenesis and adipogenesis through peroxisome proliferator-activated receptor γ (PPARγ) and Wnt/β-catenin signaling pathways. Lipid substances, such as triglycerides, cholesterol, phospholipids, glycolipids, and bile acids, play crucial roles in bone metabolism. Excessive lipid accumulation inhibits osteogenesis, while appropriate lipid levels can improve bone mass. Inflammation and oxidative stress are key pathological changes in osteoporosis, with inflammatory factors like IL-1 and TNF-α promoting osteoclast differentiation and oxidative damage inhibiting osteogenesis. Obesity, a high-risk factor for osteoporosis, increases the risk of fracture and accelerates bone loss through the redistribution of adipose tissue and the release of inflammatory factors. The review concludes that adjusting lipid content and proportion, alleviating inflammatory storms, and reducing oxidative damage can improve bone mass and treat osteoporosis.