Osteoporosis (OP) is a prevalent chronic metabolic bone disorder characterized by decreased bone mineral density, deterioration of bone microarchitecture, and increased fracture risk. Traditional Chinese medicines (TCM) have demonstrated considerable therapeutic potential in OP management due to their osteogenic and anti-resorptive activities. However, the therapeutic efficacy of TCM is often limited by the drawbacks of conventional delivery systems, underscoring the need for advanced formulation strategies to fully exploit their potential in OP prevention and treatment. In recent years, nanomedicine has emerged as a transformative platform for drug delivery, offering new avenues to enhance the pharmacological performance of herbal medicines. Nano-based delivery systems for anti-osteoporotic herbal compounds provide multiple benefits, including protection of active ingredients from degradation, improved bioavailability, reduced gastrointestinal irritation, and superior therapeutic outcomes. This review provides a comprehensive overview of the nanocarriers employed in the delivery of TCM, summarizes the current status and therapeutic efficacy of herb-loaded nanomedicines in OP management, and discusses the challenges and future directions for clinical translation. By highlighting recent advances and addressing existing hurdles, this review aims to contribute valuable insights for optimizing TCM-based nanotherapeutics in the prevention and treatment of osteoporosis.