| Osteoporosis (OP) is a common metabolic disease in clinic. Studies have found that the imbalance between osteoblast-mediated osteogenesis and osteoclast-mediated bone resorption is the key pathological mechanism of the occurrence and development of OP, which involves a series of complex and highly regulated cytokines and signal pathways. According to the various regulation mechanisms of bone homeostasis, calcitonin and bisphosphonate are mainly used to treat OP. However, many drugs have certain side effects or are not suitable for long-term use. OP may be caused by excessive drinking, glucocorticoid abuse, and estrogen deficiency. Experiments have proved that traditional Chinese medicine may treat OP by improving estrogen secretion, trace element metabolism, and regulating immune stress. As unique macromolecular substances in traditional Chinese medicine, polysaccharides have biological activities such as anti-cancer, anti-inflammation, and antioxidant injury. They regulate bone homeostasis by inhibiting osteoblast apoptosis, promoting osteoblast differentiation, inhibiting osteoclast activity, antioxidant stress, and regulating immune inflammation, and effectively curb postmenopausal osteoporosis (POP) and glucocorticoid-induced osteoporosis (GIOP). It provides a new idea for the clinical treatment of OP. Therefore, by searching the relevant Chinese and English literature, this paper systematically reviews the imbalance between osteoblast and osteoclast homeostasis leading to OP. Traditional Chinese medicine polysaccharides regulate bone tissue homeostasis and treat OP through the above ways. This provides a scientific basis for the intervention with traditional Chinese medicine polysaccharides in OP. |