Osteoporosis and associated skeletal pathologies impose a staggering global health burden, disproportionately impacting elderly populations and postmenopausal women. At the root of excessive bone resorption and stalled osteogenesis lie persistent oxidative stress and chronic inflammation. Enter resveratrol, a naturally occurring polyphenol derived from red wine and grapes, which has surfaced as a compelling therapeutic candidate for skeletal preservation owing to its robust antioxidant and anti-inflammatory capacities. Herein, we evaluate the molecular pathways through which resveratrol governs bone metabolism, focusing sharply on SIRT1-driven suppression of NF-κB signaling. Integrating findings across cell cultures, animal models, and clinical trials yields a unified perspective on these osteoprotective mechanisms. Dual benefits define resveratrol's impact on skeletal architecture: it stimulates osteoblast differentiation and mineralization while suppressing osteoclastogenesis and bone resorption. Primarily, these outcomes stem from the activation of SIRT1, a NAD + -dependent deacetylase acting as a negative regulator of NF-κB transcription. Through SIRT1-mediated deacetylation of the NF-κB p65 subunit, the transcription of pro-inflammatory cytokines including IL-1β, TNF-α, and IL-6 diminishes, subsequently dampening RANKL-driven osteoclastogenesis. Simultaneously, through the SIRT1-dependent engagement of Nrf2/ARE pathways, antioxidant defenses are bolstered, sparing bone cells from oxidative stress-induced apoptosis. Substantial preclinical promise notwithstanding, hurdles persist regarding both systemic bioavailability and the standardization of ideal dosing protocols for bone preservation. This review provides a mechanistic framework to evaluate resveratrol as a viable nutraceutical modality for the prevention and management of osteoporosis.
