Osteoporosis is a common clinical bone disease caused by a variety of causes, it increases osteoclast production mainly by changing the inflammatory microenvironment of the body, the end result is increased bone resorption and decreased bone mass. Paradoxical bone formation is a process that regulates bone formation and increases bone mass, it can affect macrophage efferocytosis by regulating apoptosis in some osteoblasts, ultimately promoting osteoblast differentiation. Osteoblasts are mainly involved in bone formation, osteoclasts are involved in bone resorption, both of them mediate the regulation of bone homeostasis, and about 50% of the osteoblasts that underwent bone remodeling under normal homeostasis were apoptotic. When promoting the apoptosis of osteoblasts to paradoxical bone formation occurs, macrophages are recruited and perform efferocytosis, under the action of efferocytosis, macrophages were polarized into M2 macrophages, M2 macrophages regulate osteoblast differentiation, inhibit osteoclast generation, and inhibit bone resorption, at the same time, it enables the new osteoblasts to occupy the place of the original osteoblasts and continue to participate in bone formation. Because the amount of bone formation of the new osteoblasts is higher than that of the original osteoblasts, the final result is an increase in bone mass after apoptosis compared to before apoptosis. Promoting the apoptosis of some osteoblasts in the body with osteoporosis may reverse increase bone mass, paradoxical bone formation may be a new direction for the treatment of osteoporosis. Therefore, this paper proposes the treatment of osteoporosis by "paradoxical bone formation" and analyzes its related mechanism, in order to provide new ideas for the research and treatment of osteoporosis.