| Osteoporosis is a kind of systemic bone disease characterized by bone loss. Its incidence has shown a high trend. Bone marrow-derived mesenchymal stem cells (BMSC) are adult stem cells with high plasticity. They can be differentiated into osteoblasts, adipocytes, and chondrocytes. Their differentiation affects the balance of bone metabolism between bone formation and bone resorption. In the bone marrow microenvironment, the differentiation fate of BMSC is regulated by Wnt, Notch, Hedgehogs and BMP signaling pathways and lncRNAs, circRNAs, and exosomes, which together form a complex and large regulatory network and have positive or negative regulatory effects on bone fat differentiation of BMSC. Therefore, the imbalance of bone formation and lipid formation of BMSC may aggravate the degree of bone marrow fat, trigger the body inflammatory response, lead to bone metabolism disorders, and then induce osteoporosis. Many studies have shown that inhibiting the adipogenic differentiation of BMSC and promoting its osteogenic differentiation is one of the important strategies for the treatment of osteoporosis. However, there are few reports about osteoporosis induced by the imbalance of bone fat differentiation of BMSC in the nation. In view of this, on the basis of comprehensive national and international literature, this paper summarizes the relevant signal pathways regulating the differentiation of BMSC to bone fat, and discusses the influence of the imbalance of BMSC to bone fat differentiation on the occurrence and development of osteoporosis, aiming to provide theoretical basis for the treatment of osteoporosis and the development of targeted drugs. |