A Scientific Look at How Traditional Chinese Medicine Could Treat Osteoporosis in Diabetics

Diabetes-induced osteoporosis (DOP) is a significant and growing health concern, particularly amongst older people. This condition arises when diabetes worsens osteoporosis, a disease that weakens bones and makes them more susceptible to fractures. The link between the two conditions complicates treatment, prompting a search for more effective solutions. For centuries, Traditional Chinese Medicine (TCM) has utilised herbal remedies to support bone health, and modern science is now beginning to investigate their potential for managing DOP.

One of the most promising TCM formulations is a combination of two herbs: Shu Di Huang (Rehmannia root) and Shan Zhu Yu (Cornus fruit). In the principles of TCM, these herbs are thought to nourish 'kidney yin', which is considered fundamental to maintaining bone strength. Recent research, employing sophisticated scientific techniques, has begun to unveil the biochemical mechanisms behind this ancient wisdom.

What is Diabetes-Induced Osteoporosis?

Diabetes-induced osteoporosis occurs when persistently high blood sugar levels interfere with the body's natural process of bone maintenance. Over time, this disruption leads to a loss of bone density and structural integrity, increasing the risk of fractures. Effectively managing this condition is crucial for preventing debilitating injuries and maintaining a good quality of life.

Whilst modern medicine focuses on blood sugar's direct impact, TCM offers a different perspective. It suggests that the kidneys govern bone and marrow production; therefore, a deficiency in Kidney energy or Yin leads to weaker bones. This philosophy makes remedies designed to support the kidneys an appealing option for treating DOP.

Unveiling the Mechanism: A Modern Scientific Investigation

A groundbreaking study by the Zhejiang University of Chinese Medicine explored how this herbal combination improves bone health in diabetic osteoporosis. The researchers used a multi-faceted approach, employing advanced methods like Ultra-Performance Liquid Chromatography, Micro-CT imaging, and network pharmacology to map out the remedy's molecular actions.

Key Findings from the Study

1. Identifying the Active Compounds:

The analysis identified 56 distinct compounds within the herbal formula. Through network pharmacology, which maps complex biological interactions, researchers pinpointed 17 key bioactive ingredients believed to be primarily responsible for the therapeutic effects. These include compounds such as Shan Zhu Yu Glycoside and Hydroxycinnamic acid.

2. Improving Bone Metabolism:

The study, conducted on diabetic rats, observed that the herbal remedy significantly reduced markers associated with bone breakdown, such as Urinary Calcium (U-Ca) and CTX-1. This indicates that the formula helps to slow down the excessive rate of bone loss commonly seen in diabetes.

3. Restoring Bone Microstructure:

Using high-resolution Micro-CT imaging, researchers could visually confirm the remedy's positive effects. The bone microstructure of the treated rats showed significant improvement. Key metrics, including Bone Mineral Density (BMD) and Trabecular Number (Tb.N), increased considerably, suggesting the formula has the potential to reverse some of the structural damage caused by diabetes.

4. Activating a Key Cellular Pathway:

Perhaps the most significant finding was the remedy's effect on a cellular signalling pathway known as PI3K/AKT. This pathway is vital for regulating cell growth, survival, and differentiation – including that of osteoblasts, the cells responsible for building new bone. By activating this pathway, the herbal formula promoted the creation and activity of these bone-building cells. This was further evidenced by increased levels of crucial bone-forming proteins like Collagen-1 (COL-1) and Bone Morphogenetic Protein-2 (BMP-2).

5. Reducing Inflammation:

Chronic, low-grade inflammation is a hallmark of diabetes and a known contributor to bone degradation. The study showed that the Shu Di Huang and Shan Zhu Yu combination lowered levels of pro-inflammatory proteins (cytokines) like TNF-α and IL-17, which can damage bone tissue. This anti-inflammatory action creates a more favourable environment for bone repair and regeneration.

The Role of This Remedy in Modern Osteoporosis Treatment

This research provides a strong scientific basis for considering the combination of Shu Di Huang and Shan Zhu Yu in the management of diabetes-induced osteoporosis. By influencing multiple biological processes—from activating the bone-building PI3K/AKT pathway to reducing inflammation—the formula offers a holistic approach to preventing and potentially reversing bone loss.

For individuals with diabetes, it may offer a valuable complementary therapy to be used alongside conventional treatments that focus on controlling blood sugar and improving bone density.

Benefits:

Enhances Bone Density: Helps increase Bone Mineral Density (BMD) to protect against fractures.

Supports Bone Formation: Encourages the activity of osteoblasts, the body's bone-building cells.

Reduces Harmful Inflammation: Lowers the levels of inflammatory proteins that contribute to bone damage.

Activates Key Signalling Pathways: Stimulates the PI3K/AKT pathway, which is essential for bone regeneration and strength.

A Promising Bridge Between Tradition and Science

Whilst diabetes-induced osteoporosis presents a complex challenge, this traditional herbal remedy of Shu Di Huang and Shan Zhu Yu offers a promising natural approach. Backed by rigorous scientific analysis, it has demonstrated a clear potential to improve bone metabolism, reduce inflammation, and promote regeneration in diabetic models.

Hu, S. J., Chen, G. C., Wang, F. Y., Fang, Y. Q., Wang, S. Q., Song, Z. L., Zhao, Z. H., Zhang, Q. L., Meng, X. Y., Zhang, Q. Y., & Qin, L. P. (2025). Network pharmacology analysis uncovers the mechanism of Shudihuang-Shanzhuyu herb pair in prevention and treatment of diabetic osteoporosis via PI3K/AKT pathway. Journal of ethnopharmacology, 345, 119581. https://doi.org/10.1016/j.jep.2025.119581