ESR1 and osteoporosis: For example, SIRT1 is regulated by the HIF-1α signaling pathway, which deacetylates sclerostin and activates the Wnt/β-catenin signaling pathway, leading to increased bone anabolism in osteoporosis.947 In postmenopausal osteoporosis, SIRT6 has been found to inhibit age-related bone loss by stabilizing ER alpha in preosteoblastic cells.948 Moreover, SIRTs not only regulate oxidative stress and aging signaling pathways to resist osteoporosis, but can also be activated by small molecule drugs such as resveratrol to affect bone metabolism.