Osteoporosis is a systemic metabolic bone disease characterized by low bone mass and deterioration of bone microarchitecture. In traditional Chinese medicine, osteoporosis is related to kidney and spleen deficiency. The eight extraordinary channels, particularly the thoroughfare, conception, and governor channels, serve as a critical pathway connecting the congenital foundation (kidney) and the acquired foundation (spleen), responsible for transporting and distributing kidney essence and infusing qi and blood to nourish the body. The dai channel, wei channel, and qiao channel contribute to skeletal homeostasis by regulating qi and blood circulation, harmonizing the external and internal aspects of the body, and modulating circadian rhythms. If kidney and spleen deficiency leads to debility of the eight extraordinary channels, it will affect skeletal homeostasis, resulting in osteoporosis. Therefore, the pathogenesis of osteoporosis is the debility of the eight extraordinary channels leading to bone malnourishment. Among them, debility of the thoroughfare, conception, and governor channels is a key factor in disease onset, whereas dysfunction of the dai channel, wei channel, and qiao channel is a critical link in disease progression. For treatment, unblocking and supplementing the extraordinary channels should be adopted, using Guilu Erxian Glue to restore the debility of the thoroughfare, conception, and governor channels, filling the essence and blood, and warmly invigorating kidney yang. Gusuibu (Drynariae Rhizoma) can be added if combined with a fracture. In cases of severe yang deficiency, Buguzhi (Psoraleae Fructus) and Yinyanghuo (Epimedii Folium) can be incorporated. For yin deficiency, Shanyurou (Corni Fructus) and Shudihuang (Rehmanniae Radix Praeparata) are applicable. During spleen deficiency, Huangqi (Astragali Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) can be included. For blood stasis, Jiuxiangchong (Coridius) can be used. Combined with external therapies, such as acupuncture and moxibustion to regulate the meridian qi of the dai channel, wei channel and qiao channel can promote circulation as a form of tonification, thereby restoring the function of the eight extraordinary channels in transporting and distributing essence and blood and nourishing the bones.