Osteoporosis is a systemic
metabolic bone disease with characteristics of bone loss and microstructural degeneration. The personal and societal costs of
osteoporosis are increasing year by year as the ageing of population, posing challenges to public health care. Homing disorders, impaired capability of osteogenic differentiation, senescence of mesenchymal stem cells (MSCs), an imbalanced microenvironment, and disordered immunoregulation play important roles during the pathogenesis of
osteoporosis. The MSC
transplantation promises to increase osteoblast differentiation and block osteoclast activation, and to rebalance bone formation and resorption. Preclinical investigations on MSC
transplantation in the
osteoporosis treatment provide evidences of enhancing osteogenic differentiation, increasing bone mineral density, and halting the deterioration of
osteoporosis. Meanwhile, the latest techniques, such as gene modification, targeted modification and co-
transplantation, are promising approaches to enhance the
therapeutic effect and efficacy of MSCs. In addition, clinical trials of MSC
therapy to treat
osteoporosis are underway, which will fill the gap of clinical data. Although MSCs tend to be effective to treat
osteoporosis, the urgent issues of safety, transplant efficiency and standardization of the manufacturing process have to be settled. Moreover, a comprehensive evaluation of clinical trials, including safety and efficacy, is still needed as an important basis for clinical translation.