The gut microbiota has emerged as a significant factor influencing bone health, with emerging evidence suggesting its critical role in the development and management of osteoporosis, particularly in postmenopausal women. This review explores the complex interactions between gut microbiota and bone metabolism, focusing on the mechanisms linking microbial communities to bone health. We discuss how microbial dysbiosis—characterized by an imbalance in gut microbial composition—can contribute to osteoporosis through inflammation and impaired nutrient absorption. Additionally, we examine the influence of estrogen on gut microbiota and its subsequent impact on bone health. The role of nutritional interventions, including prebiotics, probiotics, and synbiotics, in modulating gut microbiota and improving bone density is also evaluated. Current clinical evidence supports the potential of these interventions in osteoporosis management, highlighting the need for further research to optimize therapeutic strategies. This review underscores the importance of integrating gut microbiota modulation into osteoporosis prevention and treatment protocols.