Histone acetylation orchestrates a complex symphony of gene expression that controls cellular fate and activities, including the intricate processes of bone remodeling. Despite its proven significance, a systematic illustration of this process has been lacking due to its complexity, impeding clinical application. In this review, we delve into the central regulators of histone acetylation, unveiling their multifaceted roles in modulating bone physiology. We explore both contradictory and overlapping roles among these regulators and assess their potential as therapeutic targets for various bone disorders. Furthermore, we highlight current applications and discuss looming questions for a more effective use of epigenetic therapy in bone diseases, aiming to address gaps in knowledge and clinical practice. By providing a panoramic view of histone acetylation’s impact on bone health and disease, this review unveils promising avenues for therapeutic intervention and enhances our understanding of skeletal physiology, crucial for improving therapeutical outcomes and quality of patients’ life.The regulatory network of histone acetylation and deacetylation in bone remodeling. Osteoblasts and osteoclasts are the central functioning cells in bone remodeling. Osteoblasts derive from MSCs and require two-stage differentiation, while macrophages must undergo differentiation, fusion, and activation to form osteoclasts. In osteoblast formation, the direct acetylation changes of BMP2/4, Wnt, RUNX2 and CCN1, can indirectly alter the expression of osteoblastic genes. In osteoclast formation, HATs and HDACs mainly modify RANKL, NFATc1, and M-CSF to influence osteoclastic genes' expression. Abbreviation: RUNX2 (Runt-related transcription factor 2); OSX (Osterix); COL1a1 (Collagen, type I, alpha 1); RANKL (Receptor activator of nuclear kappa-b ligand); OPG (Osteoprotegerin); OCN (Osteocalcin); CCN1 (Recombinant human cyr61); Nrf2 (Nuclear factor erythroid 2-related factor 2); TGF-β (Transforming growth factor beta); BMP (Bone morphogenetic protein); HAT (Histone acetyltransferase); HDAC (Histone deacetylase); M-CSF (43 Macrophagecolony stimulating factor); NFATC1 (Nuclear factor of activated T-cells c1); MITF (Microphthalmia-associated transcription factor); CXCL12 (Chemokine (C-X-C motif) ligand 12)The regulatory network of histone acetylation and deacetylation in bone remodeling. Osteoblasts and osteoclasts are the central functioning cells in bone remodeling. Osteoblasts derive from MSCs and require two-stage differentiation, while macrophages must undergo differentiation, fusion, and activation to form osteoclasts. In osteoblast formation, the direct acetylation changes of BMP2/4, Wnt, RUNX2 and CCN1, can indirectly alter the expression of osteoblastic genes. In osteoclast formation, HATs and HDACs mainly modify RANKL, NFATc1, and M-CSF to influence osteoclastic genes' expression. Abbreviation: RUNX2 (Runt-related transcription factor 2); OSX (Osterix); COL1a1 (Collagen, type I, alpha 1); RANKL (Receptor activator of nuclear kappa-b ligand); OPG (Osteoprotegerin); OCN (Osteocalcin); CCN1 (Recombinant human cyr61); Nrf2 (Nuclear factor erythroid 2-related factor 2); TGF-β (Transforming growth factor beta); BMP (Bone morphogenetic protein); HAT (Histone acetyltransferase); HDAC (Histone deacetylase); M-CSF (43 Macrophagecolony stimulating factor); NFATC1 (Nuclear factor of activated T-cells c1); MITF (Microphthalmia-associated transcription factor); CXCL12 (Chemokine (C-X-C motif) ligand 12)Graphical Abstract: Histone acetylation orchestrates a complex symphony of gene expression that controls cellular fate and activities, including the intricate processes of bone remodeling. Despite its proven significance, a systematic illustration of this process has been lacking due to its complexity, impeding clinical application. In this review, we delve into the central regulators of histone acetylation, unveiling their multifaceted roles in modulating bone physiology. We explore both contradictory and overlapping roles among these regulators and assess their potential as therapeutic targets for various bone disorders. Furthermore, we highlight current applications and discuss looming questions for a more effective use of epigenetic therapy in bone diseases, aiming to address gaps in knowledge and clinical practice. By providing a panoramic view of histone acetylation’s impact on bone health and disease, this review unveils promising avenues for therapeutic intervention and enhances our understanding of skeletal physiology, crucial for improving therapeutical outcomes and quality of patients’ life.The regulatory network of histone acetylation and deacetylation in bone remodeling. Osteoblasts and osteoclasts are the central functioning cells in bone remodeling. Osteoblasts derive from MSCs and require two-stage differentiation, while macrophages must undergo differentiation, fusion, and activation to form osteoclasts. In osteoblast formation, the direct acetylation changes of BMP2/4, Wnt, RUNX2 and CCN1, can indirectly alter the expression of osteoblastic genes. In osteoclast formation, HATs and HDACs mainly modify RANKL, NFATc1, and M-CSF to influence osteoclastic genes' expression. Abbreviation: RUNX2 (Runt-related transcription factor 2); OSX (Osterix); COL1a1 (Collagen, type I, alpha 1); RANKL (Receptor activator of nuclear kappa-b ligand); OPG (Osteoprotegerin); OCN (Osteocalcin); CCN1 (Recombinant human cyr61); Nrf2 (Nuclear factor erythroid 2-related factor 2); TGF-β (Transforming growth factor beta); BMP (Bone morphogenetic protein); HAT (Histone acetyltransferase); HDAC (Histone deacetylase); M-CSF (43 Macrophagecolony stimulating factor); NFATC1 (Nuclear factor of activated T-cells c1); MITF (Microphthalmia-associated transcription factor); CXCL12 (Chemokine (C-X-C motif) ligand 12)The regulatory network of histone acetylation and deacetylation in bone remodeling. Osteoblasts and osteoclasts are the central functioning cells in bone remodeling. Osteoblasts derive from MSCs and require two-stage differentiation, while macrophages must undergo differentiation, fusion, and activation to form osteoclasts. In osteoblast formation, the direct acetylation changes of BMP2/4, Wnt, RUNX2 and CCN1, can indirectly alter the expression of osteoblastic genes. In osteoclast formation, HATs and HDACs mainly modify RANKL, NFATc1, and M-CSF to influence osteoclastic genes' expression. Abbreviation: RUNX2 (Runt-related transcription factor 2); OSX (Osterix); COL1a1 (Collagen, type I, alpha 1); RANKL (Receptor activator of nuclear kappa-b ligand); OPG (Osteoprotegerin); OCN (Osteocalcin); CCN1 (Recombinant human cyr61); Nrf2 (Nuclear factor erythroid 2-related factor 2); TGF-β (Transforming growth factor beta); BMP (Bone morphogenetic protein); HAT (Histone acetyltransferase); HDAC (Histone deacetylase); M-CSF (43 Macrophagecolony stimulating factor); NFATC1 (Nuclear factor of activated T-cells c1); MITF (Microphthalmia-associated transcription factor); CXCL12 (Chemokine (C-X-C motif) ligand 12) [ABSTRACT FROM AUTHOR]