Abstract
Panax ginseng is a medicinal and food-homologous herb with a long-standing reputation as a tonic. Extensive research has explored its potential in improving osteoporosis, a condition characterized by progressive bone loss that increases the risk of fractures. In this review, PubMed, Web of Science, Google Scholar, China National Knowledge Infrastructure, and Chinese Medical Journal Database are searched with no lower time limit up to August 2024. This review offers a comprehensive overview of how P. ginseng and its formulations can enhance bone health and alleviate osteoporosis. It also explores the signaling pathways influenced by compounds derived from P. ginseng in bone turnover. P. ginseng shows promise in regulating sex hormones, exerting antioxidant and anti-inflammatory effects, and enhancing bone turnover. It suppresses MAPKs and NF-κB pathways to inhibit bone resorption, while activating pathways like Wnt/β-catenin, AMPK, PI3K/Akt, and BMP/Smad to promote bone formation. In addition, this review describes the global production and trade of ginseng, the metabolism of P. ginseng after oral ingestion, and network pharmacology studies. Given its multi-target mechanisms, P. ginseng shows promise in the clinical management of osteoporosis. At doses below 10 g with sustained use (several months to one year), it may serve as a viable daily supplement for bone health maintenance. Furthermore, its synergistic interactions with conventional anti-osteoporosis drugs (e.g., bisphosphonates) could enhance therapeutic efficacy, positioning it as a complementary adjunct in clinical treatment regimens.