Osteoporosis is a common bone disease that is a significant health problem in the elderly. Ferroptosis as a new type of cell death plays an important role in the onset and development of osteoporosis. Regulation of iron metabolism helps in the treatment of this disease. The article describes the molecular mechanism of ferroptosis in osteoporosis and the three-dimensional regulatory network involving iron metabolism disorder, lipid peroxidation and bone homeostasis imbalance. It evaluates natural active substances with the potential to inhibit ferroptosis, including traditional Chinese medicine, from the perspective of natural product chemistry and molecular pharmacology. It discusses the prospects for research and development of delivery systems for these natural components in the treatment of osteoporosis. These advances provide new opportunities to improve the management of osteoporosis and the quality of life of older patients. The article comprehensively summarizes studies on ferroptosis and osteoporosis and serves as a reference for research and clinical practice.