The impact of exosomes on bone health: A focus on osteoporosis

Osteoporosis is a widespread chronic condition. Although standard treatments are generally effective, they are frequently constrained by side effects and the risk of developing drug resistance. A promising area of research is the investigation of extracellular vesicles (EVs), including exosomes, microvesicles, and apoptotic bodies, which play a crucial role in bone metabolism. Exosomes, in particular, have shown significant potential in both the diagnosis and treatment of osteoporosis. EVs derived from osteoclasts, osteoblasts, mesenchymal stem cells, and other sources can influence bone metabolism, while exosomes from inflammatory and tumor cells may exacerbate bone loss, highlighting their dual role in osteoporosis pathology. This review offers a comprehensive overview of EV biogenesis, composition, and function in osteoporosis, focusing on their diagnostic and therapeutic potential. We examine the roles of various types of EVs and their cargo—proteins, RNAs, and lipids—in bone metabolism. Additionally, we explore the emerging applications of EVs as biomarkers and therapeutic agents, emphasizing the need for further research to address current challenges and enhance EV-based strategies for managing osteoporosis. •Exosomes influence bone homeostasis by affecting key bone cells like MSCs, osteoblasts, and osteoclasts.•The dual role of extracellular vesicles (EVs) in promoting and inhibiting bone loss highlights their complexity in osteoporosis.•Exosomes show therapeutic potential, but their regulatory mechanisms in osteoporosis remain largely unknown.•Enhancing exosome isolation and purification is vital for their therapeutic use in osteoporosis.