Geng XR, Liu Y. Diabetic osteoporosis: Focus on ferroptosis as a key player and future prospect in traditional Chinese medicine. World J Diabetes 2026; 17(7): 119692 [DOI: 10.4239/wjd.119692]
Corresponding Author of This Article
Yang Liu, Chief Physician, Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Huanggu District, Shenyang 110032, Liaoning Province, China. liuyang_linda@163.com
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Endocrinology & Metabolism
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review-article
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Geng XR, Liu Y. Diabetic osteoporosis: Focus on ferroptosis as a key player and future prospect in traditional Chinese medicine. World J Diabetes 2026; 17(7): 119692 [DOI: 10.4239/wjd.119692]
World J Diabetes. Jul 15, 2026; 17(7): 119692 Published online Jul 15, 2026. doi: 10.4239/wjd.119692
Diabetic osteoporosis: Focus on ferroptosis as a key player and future prospect in traditional Chinese medicine
Xin-Ran Geng, Yang Liu
Xin-Ran Geng, The First Clinical College, Liaoning University of Traditional Chinese Medicine, Shenyang 110874, Liaoning Province, China
Yang Liu, Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
Co-first authors: Xin-Ran Geng and Yang Liu.
Author contributions: Geng XR and Liu Y made equal contributions as co-first authors; Geng XR contributed to conceptualization, literature search and collection, manuscript writing and original draft preparation; Liu Y contributed to supervision, manuscript review and editing, and critical revision of the article for important intellectual content. Both authors have read and agreed to the published version of the manuscript.
AI contribution statement: No ChatGPT, Grammarly, DeepL, or any other artificial intelligence tool was involved in the generation of any part of the main text of this manuscript; the entire content was independently conceived and written by the authors. AI tools were not applied to data analysis or core academic writing. In addition, no artificial intelligence tool participated in the study design or result interpretation, and none of the images included in the manuscript were AI-generated.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yang Liu, Chief Physician, Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Huanggu District, Shenyang 110032, Liaoning Province, China. liuyang_linda@163.com
Received: February 3, 2026 Revised: March 23, 2026 Accepted: May 18, 2026 Published online: July 15, 2026 Processing time: 156 Days and 14.1 Hours
Abstract
Diabetic osteoporosis (DOP) is a prevalent secondary metabolic bone disease in patients with diabetes. It features progressive bone mass loss, disrupted bone microstructure, and elevated fracture risk, significantly increasing patients’ disability and mortality as well as medical costs. Ferroptosis, an iron-dependent programmed cell death mode, plays a key regulatory role in DOP pathogenesis. In the diabetic high-glucose microenvironment, ferroptosis interacts with advanced glycation end products to inhibit osteoblast differentiation, promote osteoclast activation, and impair the osteogenic potential of bone marrow mesenchymal stem cells, disrupting bone formation-resorption homeostasis and driving DOP progression. Traditional Chinese medicine (TCM) has multicomponent, multitarget, and multipathway advantages in regulating ferroptosis for DOP treatment. Single TCM herbs (e.g., baicalein and quercetin), TCM compounds (e.g., Qing’e Pill and Zuogui Pill), and electroacupuncture can regulate ferroptosis by balancing iron homeostasis, enhancing antioxidant capacity, and inhibiting lipid peroxidation, thereby restoring bone metabolism balance. This review summarizes the role and mechanism of action of ferroptosis in DOP and regulatory role of TCM, highlighting current research bottlenecks to provide directions for TCM-based DOP treatment and mechanism of action studies.
Core Tip: Diabetic osteoporosis (DOP) poses high disability and fracture risks, with high-glucose-induced bone cell ferroptosis (driven by iron overload, lipid peroxidation and system Xc-/glutathione/glutathione peroxidase 4 imbalance) as its core pathogenesis. Western medicine cannot synergistically improve glucose and bone metabolism and has side effects. This minireview focuses on the high-glucose-bone cell ferroptosis-DOP axis, clarifies ferroptosis mechanisms in key bone cells, and describes how traditional Chinese medicine (TCM) targets ferroptosis via multiple pathways to treat DOP. We bridge TCM theory and the molecular mechanisms of ferroptosis, and discuss TCM-based DOP research directions and clinical translation.
