Advances in the regulation of osteoblast metabolic senescence and osteoporosis prevention by traditional Chinese medicine via the Wnt/β-catenin signaling network

Osteoporosis (OP) remains a therapeutic challenge, partly due to the limitations of the traditional “bone resorption–bone formation imbalance” paradigm. Although the Wnt signaling pathway is known to regulate bone metabolism, a systematic framework explaining how traditional Chinese medicine (TCM) corrects osteoblast dysfunction by positioning Wnt as a central “metabolic–transcriptional hub” is lacking. This review proposes that osteoblast metabolic senescence is a key pathological driver of OP, unfolding as a multi-stage cascade of “energy reprogramming → turbid stasis accumulation → collateral fixation.” We hypothesize that this cascade parallels the TCM pathogenesis of “Kidney deficiency with essence depletion, turbid stasis obstructing collaterals.” The Wnt/β-catenin pathway may serve as a crucial molecular executor of the “Kidney governing bones” function, acting as a master switch for osteogenic differentiation and a hub integrating energy metabolism with bone formation. TCM leverages its multi-component, multi-target advantages to regulate this network: kidney-warming herbs (flavonoids) stabilize β-catenin and enhance mitochondrial function; spleen-kidney tonifying herbs (glycosides, polysaccharides) couple energy regulation with autophagy; and heat-clearing, dampness-resolving herbs (alkaloids) modulate inflammation via the gut-bone axis. Acupuncture and therapeutic exercises further improve the metabolic milieu. Future directions should focus on developing novel drugs targeting metabolic pathways, establishing precise patient subtyping based on “pattern–metabolite profiles,” and building a robust evidence chain for clinical translation.