Osteoporosis (OP) is a systemic metabolic disease of the bone microenvironment. Macrophage polarization refers to an activated state of macrophages in response to certain microenvironment changes. In this state, M1 and M2 macrophages form and play a role in increasing bone resorption, osteoclast formation, and osteoblast formation, respectively, affecting the bone microenvironment. Traditional Chinese medicine also increases bone resorption and osteoclast formation by regulating bone microenvironment metabolism.This article elucidates the therapeutic effect of traditional Chinese medicine on inhibiting M1 macrophages and promoting M2 macrophages from the perspective of macrophage polarization, thereby inhibiting bone resorption, inhibiting osteoclast formation, and increasing osteoblast formation, in order to regulate the bone microenvironment metabolism of OP.

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