BACKGROUND: Icariin is an effective active component of traditional Chinese medicine which is used to prevent osteoporosis, but the specific mechanism remains unclear. Existing studies have indicated that autophagy can participate in regulating bone metabolism; however, whether icariin can prevent osteoporosis by changing autophagy is unknown. OBJECTIVE: To investigate whether icariin can prevent osteoporosis by regulating autophagy and promoting osteoblast differentiation. METHODS: Mouse preosteoblast cell lines MC3T3-E1 in logarithmic phase were selected and treated by different concentrations of icariin (10-6 to 10-3 mmol/L). Cell viability, apoptosis rate, alkaline phosphatase activity, the number of mineralized nodules and the expression level of osteogenic differentiation markers were observed in order to determine the optimal concentration of icariin. Then cells were treated by the optimal concentration of icariin and divided into three groups: control group, icariin group, icariin+3-methyladenine group. The number of autophagosomes, the expression level of osteogenic differentiation markers and autophagy related genes, the expression level of autophagy related proteins were evaluated by MDC staining, RTqPCR and western blot assay, respectively. In an in vivo test, an ovariectomized rat model was established and all the rats were divided into four groups: sham group, ovariectomized group, icariin group, estradiol group. Micro-CT was used to detect the bone micro parameters, and western blot was used to detect the expression level of autophagy related proteins. RESULTS AND CONCLUSION: Icariin could promote the proliferation and differentiation of osteoblasts, and at the same time inhibit apoptosis of the cells. The maximum stimulatory effect of icariin was observed at the concentration of 10-5 mmol/L (P < 0.05). In addition, icariin could increase the number of autophagosomes and upregulate the expression of osteogenic differentiation markers and autophagy-related genes or proteins (P < 0.05), which were antagonized by 3-methyladenine (P < 0.05). Icariin could also improve the parameters of bone microstructure in ovariectomized rats and upregulate the expression of autophagy-related proteins (P < 0.05). All these findings indicate that icariin can prevent osteoporosis by activating autophagy and promoting osteoblast differentiation. [ABSTRACT FROM AUTHOR]