Osteoporosis is a common systemic metabolic disease characterized by reduced bone density and mass, destruction of bone tissue microstructure, and increased bone fragility leading to fracture susceptibility. Current pharmacological treatments for osteoporosis focus on inhibiting bone resorption, promoting bone formation, and maintaining bone homeostasis. However, most drugs have limited targets and high toxicity. Traditional Chinese medicine (TCM) offers a wide range of herbal remedies, with many plants showing potential in regulating the relationship between osteoporosis and the immune system. Acupuncture has also shown significant therapeutic effects in combination with TCM for osteoporosis. The mechanisms of TCM in treating osteoporosis are not fully understood, and there is a need for further research into the pathological signaling pathways and key molecules involved in osteoporosis. This review discusses the current status and future developments of anti-osteoporosis drugs, including bone formation promoting drugs, bone resorption inhibiting drugs, bone nutrient drugs, and new anti-osteoporosis drugs. It also explores the role of natural Chinese medicine and acupuncture in the treatment of osteoporosis. The review highlights the importance of understanding the pathogenesis of osteoporosis and developing new therapeutic strategies to improve bone health and reduce fracture risk. The article also discusses the role of hormones, the immune system, and bone remodeling in the development of osteoporosis. The review emphasizes the need for further research into the mechanisms of TCM in treating osteoporosis and the potential of natural Chinese medicine and acupuncture in the treatment of osteoporosis. The review concludes that a better understanding of the pathogenesis of osteoporosis is crucial for the development of new therapeutic strategies and drug treatments.Osteoporosis is a common systemic metabolic disease characterized by reduced bone density and mass, destruction of bone tissue microstructure, and increased bone fragility leading to fracture susceptibility. Current pharmacological treatments for osteoporosis focus on inhibiting bone resorption, promoting bone formation, and maintaining bone homeostasis. However, most drugs have limited targets and high toxicity. Traditional Chinese medicine (TCM) offers a wide range of herbal remedies, with many plants showing potential in regulating the relationship between osteoporosis and the immune system. Acupuncture has also shown significant therapeutic effects in combination with TCM for osteoporosis. The mechanisms of TCM in treating osteoporosis are not fully understood, and there is a need for further research into the pathological signaling pathways and key molecules involved in osteoporosis. This review discusses the current status and future developments of anti-osteoporosis drugs, including bone formation promoting drugs, bone resorption inhibiting drugs, bone nutrient drugs, and new anti-osteoporosis drugs. It also explores the role of natural Chinese medicine and acupuncture in the treatment of osteoporosis. The review highlights the importance of understanding the pathogenesis of osteoporosis and developing new therapeutic strategies to improve bone health and reduce fracture risk. The article also discusses the role of hormones, the immune system, and bone remodeling in the development of osteoporosis. The review emphasizes the need for further research into the mechanisms of TCM in treating osteoporosis and the potential of natural Chinese medicine and acupuncture in the treatment of osteoporosis. The review concludes that a better understanding of the pathogenesis of osteoporosis is crucial for the development of new therapeutic strategies and drug treatments.