Advances In Pharmacological and Alternative Therapies for Enhancing Fracture Repair in Postmenopausal Osteoporosis: a Narrative Review.

Postmenopausal osteoporosis (PMO) significantly increases the risk of fragility fractures. The profound estrogen deficiency, compounded by severe oxidative stress, ferroptosis, and an impaired osteoimmune microenvironment, disrupts the vital coupling of angiogenesis and osteogenesis. This disruption frequently leads to delayed fracture union and implant failure. This narrative review aims to consolidate the current literature regarding both conventional pharmacological interventions and specific alternative therapeutic strategies, providing a comprehensive conceptual framework for optimizing bone healing in PMO fractures. An extensive literature search of databases including the systematic-review and evidence-synthesis database, biomedical and pharmacological bibliographic database, multidisciplinary citation-indexing database, and public biomedical literature database was conducted for relevant studies published up to March 2026. While conventional antiresorptive and anabolic agents remain the gold standard for long-term secondary fracture prevention, their inherent limitations and "double-edged sword" effects during the acute fracture healing phase pose significant clinical challenges. Emerging evidence suggests that multi-target alternative therapies, particularly natural bioactive compounds and traditional Chinese medicine (TCM) formulas, offer a synergistic approach. By ameliorating systemic metabolic dysregulation and inhibiting lipid peroxidation-induced ferroptosis, these alternative therapies reshape localized immune-bone homeostasis. Addressing the delayed healing of postmenopausal fractures requires an evolution toward an integrative sequential management model. Although current supporting data predominantly derive from robust preclinical models, combining these alternative therapeutic strategies with conventional agents-and potentially utilizing advanced targeted biomaterial delivery systems-represents a highly promising frontier to optimize perioperative fracture management and enhance long-term skeletal integrity.