We investigated the effects of Gu-Sui-Bu using in vitro bone cell cultures. Primary rabbit and mouse marrow cells were cultured with or without five different concentrations of Gu-Sui-Bu extract. Osteoclast numbers were assessed using tartrate-resistant acid phosphatase (TRAP) positive cell counts and for function, osteoclast resorption pits on bovine bone slices were performed. Alkaline phosphatase (AP) positive cell counts and mineralized nodule formation were examined to assess osteoblast function with Gu-Sui-Bu. TRAP+ osteoclast numbers increased, as did the number and size of resorption pits with 0.001 mg/ml of extract. Low doses of extract did not alter AP+ colony number or mineralized nodule formation, but both were inhibited by doses of 0.1 mg/ml or higher. The highest dose of extract (10 mg/ml) inhibited proliferation of all cell types. At 0.01 and 0.001 mg/ml doses, RANKL increased over time; however, osteoprotegerin levels only increased at doses > or = 0.1 mg/ml. Resorption pit formation was decreased without alteration in mature multinucleated (TRAP+) cell counts only at the highest dose of the putative active ingredient of Gu-Sui-Bu. In summary, lower concentrations of Gu-Sui-Bu extract had positive effects on osteoclast proliferation, survival and resorptive activity that may be mediated through enhanced prostaglandin secretion. However, high doses of extract proved detrimental to osteoclast and osteoblast survival. No effect of low doses of Gu-Sui-Bu extract was seen in osteoblast cultures. High doses of the putative active ingredient of Gu-Sui-Bu showed mild inhibition of mouse osteoclast function.