Can TCM Herbs Help Treat Osteoporosis And Osteoarthritis? A Deep Dive Into Wenshen Tongluo Zhitong Decoction And Cistanche
Jan 06, 2026
Keywords: TCM herb for osteoporosis, Cistanche for bone health, Wenshen Tongluo Zhitong Decoction, HIFs/OPG/RANKL pathway, natural osteoporosis remedy, Chinese herbal treatment for bone loss.
Introduction
Osteoporosis (OP) and osteoarthritis (OA) are two of the most prevalent age-related bone disorders. Millions of elderly individuals suffer from both, leading to reduced mobility and quality of life. While conventional treatments such as bisphosphonates offer symptomatic relief, concerns about long-term side effects have sparked growing interest in Traditional Chinese Medicine (TCM).
In this article, we explore recent preclinical findings on a classic Chinese herbal formula-Wenshen Tongluo Zhitong Decoction (WSTZF)-and its effects on rats with comorbid OP and OA. We also compare the results with Cistanche, a well-known TCM herb for bone health. Together, they offer a compelling case for natural interventions in bone disease management.
📚 For further reading on Cistanche's role in osteoporosis, visit:
Research Progress Of Total Glycosides Of Cistanche In The Treatment Of Osteoporosis
Study Overview: Treating OP and OA with WSTZF
In a controlled animal study conducted by researchers in Inner Mongolia, rats were divided into five groups:
Sham-operated control
Model group (induced OP + OA)
Alendronate group (standard pharmaceutical treatment)
Low-dose WSTZF group
High-dose WSTZF group
The OP+OA model was established using bilateral ovariectomy and a modified Hulth method to simulate joint degeneration.
Key Findings at a Glance:
| Parameter | Outcome with WSTZF |
|---|---|
| Bone Density | Significantly increased in high-dose group |
| Cartilage Surface | Repaired, with fewer defects and smoother texture |
| Inflammatory Markers | TNF-α & IL-1β levels significantly reduced |
| Structural Proteins | COL2A1 & COL1A2 increased, MMP9 & MMP13 decreased |
| Signaling Pathways | Modulated HIF-1α/HIF-2α and OPG/RANKL ratios |
Section 1: Macroscopic and Microscopic Joint Improvements
1.1 Collins and Mankin Scores
Collins Score: Rats treated with WSTZF showed lower scores, indicating less cartilage damage.
Mankin Score: Both low and high doses of WSTZF significantly improved cartilage structure.
1.2 Bone Microstructure
Model rats had severe bone loss, reduced BV/TV (bone volume fraction), and increased trabecular spacing (Tb.Sp).
WSTZF, especially at high doses, reversed these changes and improved bone microarchitecture.
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Section 2: Inflammatory and Molecular Markers
2.1 Cytokines and Protein Expression
WSTZF reduced systemic inflammation by lowering TNF-α, IL-1β, and RANKL.
It increased OPG and the OPG/RANKL ratio, crucial for reducing osteoclast-mediated bone resorption.
2.2 HIF Signaling Modulation
Hypoxia-inducible factors (HIF-1α and HIF-2α) play opposing roles in bone metabolism:
WSTZF increased HIF-1α, promoting bone protection.
It decreased HIF-2α and EGLN, which are associated with cartilage degradation and osteoclast activation.
Table 1. Comparison of Knee Joint Collins Scores Among Rats in Each Group
(Score, mean ± SD)
| Group | n | Collins Score (mean ± SD) |
|---|---|---|
| Sham-operated group | 7 | 0.29 ± 0.49 |
| Model group | 7 | 3.43 ± 0.53ᵃ |
| WSTZF Low Dose | 7 | 2.43 ± 0.55ᵇ |
| WSTZF High Dose | 7 | 2.00 ± 0.53ᵇ |
| Alendronate group | 7 | 1.86 ± 0.69ᵇ |
Table 2. Bone Mineral Density at the Distal Femur and Subchondral Bone Microstructure of the Tibial Plateau
(mean ± SD)
| Group | n | Bone Density (g/cm²) | BV/TV (%) | Tb.Sp (μm) |
|---|---|---|---|---|
| Sham-operated group | 5 | 0.53 ± 0.05 | 66.63 ± 1.10 | 222.80 ± 10.42 |
| Model group | 5 | 0.30 ± 0.02ᵃ | 61.86 ± 1.86ᵃ | 279.00 ± 2.26ᵃ |
| WSTZF Low Dose | 5 | 0.35 ± 0.01 | 70.91 ± 3.12ᵇ | 243.70 ± 5.52ᵇ |
| WSTZF High Dose | 5 | 0.39 ± 0.01ᵇ | 68.06 ± 1.90ᵇ | 229.20 ± 1.23ᵇ |
| Alendronate group | 5 | 0.38 ± 0.02ᵇ | 67.03 ± 2.51ᵇ | 266.90 ± 4.91ᵇ |
Figure 1 Coronal plane images and 3D reconstructions of rat knee joints detected by Micro-CT in each group
Figure 2 Pathological images of rat knee joints with HE and Safranin O-Fast Green Stainings in each group (×40)
Figure 3 Immunofluorescence staining images of HIF-1α and HIF-2α in rat knee joints of each group (×5)
Section 3: Bone-Cartilage Metabolism
WSTZF improved the expression of structural proteins:
COL2A1 and COL1A2: Increased, indicating healthy cartilage and bone collagen synthesis.
MMP9 and MMP13: Decreased, reflecting reduced matrix degradation.
RUNX2: Modulated, supporting osteoblast differentiation and bone formation.
Table 3. Comparison of Knee Joint Mankin Scores Among Rats in Each Group
(Score, mean ± SD)
| Group | n | Mankin Score (mean ± SD) |
|---|---|---|
| Sham-operated group | 5 | 1.67 ± 0.58 |
| Model group | 5 | 12.00 ± 1.00ᵃ |
| WSTZF Low Dose | 5 | 7.67 ± 0.58ᵇ |
| WSTZF High Dose | 5 | 5.33 ± 1.00ᵇ |
| Alendronate group | 5 | 6.00 ± 0.58ᵇ |
Table 4. Serum Inflammatory Factors and HIFs/OPG/RANKL Pathway Factors
(mean ± SD)
| Group | n | TNF-α (pg/ml) | IL-1β (pg/ml) | OPG (pg/ml) | RANKL (pg/ml) | OPG/RANKL | HIF-1α (ng/ml) | HIF-2α (pg/ml) |
|---|---|---|---|---|---|---|---|---|
| Sham-operated | 7 | 45.72 ± 17.93 | 74.03 ± 8.68 | 232.00 ± 51.22 | 96.85 ± 6.93 | 2.43 ± 0.69 | 0.21 ± 0.04 | 51.69 ± 9.43 |
| Model group | 7 | 169.80 ± 28.09ᵃ | 317.00 ± 29.37ᵃ | 106.00 ± 21.34ᵃ | 316.00 ± 83.79ᵃ | 0.21 ± 0.11ᵃ | 0.66 ± 0.11ᵃ | 161.20 ± 11.75ᵃ |
| WSTZF Low Dose | 7 | 97.48 ± 11.96ᵇ | 145.20 ± 35.05ᵇ | 194.70 ± 16.68ᵇ | 100.76 ± 10.68ᵇ | 0.97 ± 0.08ᵇ | 0.87 ± 0.03ᵇ | 136.30 ± 8.78ᵇ |
| WSTZF High Dose | 7 | 100.80 ± 2.86ᵇ | 103.70 ± 11.01ᵇ | 161.80 ± 10.08ᶜᵉ | 156.40 ± 9.48ᵇ | 1.04 ± 0.13ᵇ | 0.53 ± 0.07ᶜᵉ | 104.40 ± 7.05ᶜᵉ |
| Alendronate group | 7 | 57.88 ± 15.65ᶜᵉ | 78.00 ± 10.94ᶜᵉ | 138.60 ± 9.46ᶜ | 121.60 ± 36.43ᵇ | 1.24 ± 0.41ᵇ | 0.35 ± |
Section 4: Comparison with Alendronate
While alendronate effectively increased bone density, WSTZF, particularly at high doses, surpassed it in repairing cartilage damage. This suggests that WSTZF is not only a bone-protective agent but also a joint-preserving remedy.
Section 5: The Role of Cistanche in Bone Health
Cistanche (Cistanche deserticola), often called "desert ginseng," is a cornerstone herb in TCM for kidney yang deficiency, which is traditionally associated with bone weakness. Modern research confirms that Cistanche glycosides (GCs) have multiple bone-protective mechanisms:
Antioxidant effects: Scavenging free radicals and reducing oxidative stress.
Anti-inflammatory: Inhibiting cytokines like IL-6 and nitric oxide.
Bone metabolism regulation: Enhancing osteoblast activity and suppressing osteoclasts.
Pathway modulation: Influencing OPG/RANKL/RANK and Wnt/β-catenin signaling pathways.
🧪 A study by Li Qiang et al. (2025) concluded:
"GCs show significant therapeutic effects and wide application prospects in improving osteoporosis, with good safety and tolerability."
- Baotou Medical College, Inner Mongolia
Read Full Study
Figure 5 Electrophoresis images of proteins in the HIFs/ OPG/RANKL pathway in rat knee joints of each group
Table 5. Fluorescence Intensities of HIF-1α and HIF-2α in the Knee Joint
(mean ± SD)
| Group | n | HIF-1α (mean ± SD) | HIF-2α (mean ± SD) |
|---|---|---|---|
| Sham-operated | 5 | 24.35 ± 0.56 | 25.55 ± 0.49 |
| Model group | 5 | 12.87 ± 0.53ᵃ | 43.40 ± 0.53ᵃ |
| WSTZF Low Dose | 5 | 20.45 ± 0.44ᵇ | 34.30 ± 0.63ᵇ |
| WSTZF High Dose | 5 | 21.88 ± 0.80ᵇ | 28.50 ± 0.60ᶜ |
| Alendronate group | 5 | 16.86 ± 0.69ᵇᶜ | 27.45 ± 0.69ᶜ |
Table 6. Protein Levels of COL2A1, COL1A2, MMP13, MMP-9, and RUNX2 in the Knee Joint
(Relative to GAPDH, mean ± SD)
| Group | n | COL2A1 | COL1A2 | MMP13 | MMP-9 | RUNX2 |
|---|---|---|---|---|---|---|
| Sham-operated | 3 | 0.63 ± 0.05 | 1.15 ± 0.01 | 0.62 ± 0.03 | 0.52 ± 0.01 | 0.22 ± 0.01 |
| Model group | 3 | 0.31 ± 0.04ᵃ | 0.43 ± 0.01ᵃ | 1.07 ± 0.03ᵃ | 1.08 ± 0.06ᵃ | 0.91 ± 0.01ᵃ |
| WSTZF Low Dose | 3 | 1.07 ± 0.10ᵇ | 0.67 ± 0.01ᵇ | 0.69 ± 0.01ᵇ | 0.79 ± 0.01ᵇ | 0.25 ± 0.01ᵇ |
| WSTZF High Dose | 3 | 0.85 ± 0.03ᵇᶜ | 0.81 ± 0.03ᶜ | 0.63 ± 0.02ᵇ | 0.49 ± 0.02ᶜ | 0.49 ± 0.02ᶜ |
| Alendronate group | 3 | 0.72 ± 0.20ᵇ | 0.51 ± 0.02ᵇ | 0.62 ± 0.01ᵇ | 0.57 ± 0.01ᵇ | 0.52 ± 0.03ᵇ |
Table 7. Protein Levels of OPG, RANKL, HIF-1α, HIF-2α, and EGLN in the Knee Joint
(Relative to Actin, mean ± SD)
| Group | n | OPG | RANKL | OPG/RANKL | HIF-1α | HIF-2α | EGLN |
|---|---|---|---|---|---|---|---|
| Sham-operated | 3 | 0.65 ± 0.04 | 0.37 ± 0.02 | 1.77 ± 0.18 | 1.11 ± 0.05 | 0.64 ± 0.01 | 0.91 ± 0.01 |
| Model group | 3 | 0.85 ± 0.06ᵃ | 0.95 ± 0.07ᵃ | 0.91 ± 0.21ᵃ | 1.03 ± 0.12ᵃ | 0.94 ± 0.02ᵃ | 1.24 ± 0.01ᵃ |
| WSTZF Low Dose | 3 | 0.90 ± 0.04ᵇ | 0.57 ± 0.07ᵇ | 1.11 ± 0.20ᵇ | 1.37 ± 0.07ᵇ | 0.63 ± 0.05ᵇ | 0.76 ± 0.01ᵇᶜ |
| WSTZF High Dose | 3 | 0.97 ± 0.06ᶜ | 0.43 ± 0.06ᵇ | 2.22 ± 0.19ᶜ | 1.42 ± 0.08ᵇ | 0.56 ± 0.03ᵇ | 0.92 ± 0.01ᶜ |
| Alendronate group | 3 | 0.92 ± 0.05ᶜ | 0.27 ± 0.08ᶜ | 2.40 ± 0.19ᵇ | 0.86 ± 0.06ᶜ | 0.40 ± 0.02ᶜ | 0.99 ± 0.04ᶜ |
Conclusion: A Holistic TCM Approach to Bone Health
The evidence strongly supports the use of WSTZF and Cistanche as promising natural interventions for managing osteoporosis and its comorbidities. By targeting both bone density loss and cartilage degeneration, these TCM remedies offer a multi-targeted, safer alternative to conventional pharmaceuticals.
Whether you're a health practitioner, a supplement developer, or someone seeking natural ways to strengthen bones, WSTZF and Cistanche present a time-tested yet scientifically backed solution.
References
Li Qiang et al. Research Progress Of Total Glycosides Of Cistanche In The Treatment Of Osteoporosis, Baotou Medical College, 2025.
Zheng Suyang et al. Clinical Observation of WSTZF in Primary Osteoporosis, Liaoning Journal of TCM.
Knowles HJ. HIFs in Osteoclast Function, Sci Rep, 2020.
Tan JK et al. Hypoxia and Bone Metabolism, IJMS, 2021.
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