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Introduction: Osteoporosis is a progressive skeletal disorder characterized by low bone mass, microarchitectural deterioration, and increased fracture risk. With global aging, it has become a major health concern. Conventional treatments such as bisphosphonates and hormone therapy have limitations, including side effects and poor compliance. Ayurveda describes Asthi-kshaya and Asthi-majjagata vata conditions that closely resemble osteoporosis. Classical texts recommend Asthi-poshaka and Balya dravyas that support bone health and counteract degeneration. Methods: A comprehensive review was conducted through PubMed, Scopus, Web of Science, and Ayurvedic texts (Charaka Samhita, Sushruta Samhita, Bhavaprakasha). Keywords used included: “Ayurveda AND osteoporosis,” “Asthi-kshaya,” “Ayurvedic bone health herbs,” and specific herb names. Both preclinical and clinical studies published between 1950–2025 were included. Results: Ayurveda emphasizes Asthi dhatu poshana (nourishment of bone tissue) and Vata shamana (pacification of aggravated Vata) in managing osteoporosis. Herbs such as Cissus quadrangularis (Asthishrinkhala), Withania somnifera (Ashwagandha), Terminalia arjuna (Arjuna), Glycyrrhiza glabra (Yashtimadhu), and mineral formulations like Praval pishti and Shankha bhasma have been described. Pharmacological studies reveal mechanisms such as stimulation of osteoblast activity (Cissus), reduction of bone resorption (Ashwagandha), antioxidant and anti-inflammatory effects (Arjuna), and calcium bioavailability from mineral preparations. Clinical studies demonstrate improvements in bone mineral density (BMD), reduced fracture healing time, and symptomatic relief. Discussion: There is a significant correlation between Ayurvedic concepts of Asthi-kshaya and modern osteoporosis. Evidence supports anti-resorptive, anabolic, and bone-strengthening actions of Ayurvedic herbs. However, clinical trials remain limited, heterogeneous, and lacking standardization of formulations. Conclusion: Ayurvedic bone-protective drugs offer a promising complementary approach in osteoporosis management. With pharmacological validation, standardized formulations, and rigorous clinical studies, these remedies could bridge the gap between traditional knowledge and modern bone health care.

KEYWORDS: Asthi-kshaya, Ayurveda, Bone health, Osteoporosis, Pharmacological validation