Salvia miltiorrhiza: an ancient Chinese herbal medicine as a source for anti-osteoporotic drugs

J Ethnopharmacol. 2014 Sep 29;155(3):1401-16. doi: 10.1016/j.jep.2014.07.058. Epub 2014 Aug 7.


Ethnopharmacological relevance: Red sage (Salvia miltiorrhiza Bunge), also known as Danshen in Chinese, has been used historically and is currently exploited in combination with other herbs to treat skeletal diseases in traditional Chinese medicine (TCM). With the advance of modern analytical technology, a multitude of bone-targeting, pharmaceutically active, compounds has been isolated and characterized from various sources of TCM including those produced in Salvia miltiorrhiza root. The aim of the review is to provide a comprehensive overview about the historical TCM interpretation of the action of Salvia miltiorrhiza in osteoporosis, its use clinical trials, its main phytochemical constituents, and its action on bone-resorptive and bone formation-stimulating mechanisms in in vitro and in vivo studies.

Materials and methods: Literature sources used were Pubmed,,, PubChem, and the Web of Science. For the inquiry, keywords such as Salvia, danshen, osteoporosis, bone, osteoclast and osteoblast were used in various combinations. About 130 research papers and reviews were consulted.

Results: In TCM, the anti-osteopororotic effect of Salvia miltiorrhiza is ascribed to its action on liver and blood stasis as main therapeutic targets defining osteoporosis. 36 clinical trials were identified which used Salvia miltiorrhiza in combination with other herbs and components to treat post-menopausal, senile, and secondary osteoporosis. On average the trials were characterized by high efficacy (>80%) and low toxicity problems. However, various limitations such as small patient samples, short treatment duration, frequent lack of detailed numerical data, and no clear endpoints must be taken into consideration. To date, more than 100 individual compounds have been isolated from this plant and tested in various animal models and biochemical assays. Compounds display anti-resorptive and bone formation-stimulating features targeting different pathways in the bone remodeling cycle. Pathways affected include the activation of osteoblasts, the modulation of osteoclastogenesis, and the inhibition of collagen degradation by cathepsin K.

Conclusions: The inclusion of Salvia miltiorrhiza in more than 30% of all herbal clinical trials successfully targeting osteoporosis has stimulated significant interest in the identification and characterization of individual constituents of this herb. The review highlights the anti-osteoporotic potential of Salvia miltiorrhiza in clinical applications and the potential of the herb to provide potent compounds targeting specific pathways in bone resorption and bone formation.

Keywords: Anti-resorptive activity; Danshen; Osteoporosis; Pro-anabolic activity; Salvia miltiorrhiza; Salvianolic acid A, CID 5281793; caffeic acid, CID 689043; cryptotanshinone, CID 160254; oleanolic acid, CID 10494; p-coumaric acid, CID 637542; raloxifene, CID 5035; salvianolic acid B (Synonym: Salvianic acid B), CID 11629084; tanshinone I, CID 114917; tanshinone IIA, CID 164676; ursolic acid, CID 64945.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anabolic Agents / pharmacology
  • Anabolic Agents / therapeutic use
  • Animals
  • Bone Density Conservation Agents / pharmacology
  • Bone Density Conservation Agents / therapeutic use*
  • Cathepsin K / antagonists & inhibitors
  • Drugs, Chinese Herbal / pharmacology
  • Drugs, Chinese Herbal / therapeutic use*
  • Humans
  • Osteoporosis / drug therapy*
  • Phytochemicals / analysis
  • Salvia miltiorrhiza* / chemistry


  • Anabolic Agents
  • Bone Density Conservation Agents
  • Drugs, Chinese Herbal
  • Phytochemicals
  • Cathepsin K