Enhancing osteoporosis treatment: emerging roles of engineered exosomes in bone regeneration and repair

作者：Hongtao Li, Hongyu Pan, Minshan Feng · 发表于：Journal of Translational Medicine · 年份：2026 · DOI：10.1186/s12967-025-07653-2 · 被引用次数：2 · 研究领域：Extracellular vesicles in disease、MicroRNA in disease regulation、Heterotopic Ossification and Related Conditions

BACKGROUND: Osteoporosis, a prevalent metabolic bone disease, is characterized by reduced bone density and an increased risk of fractures. The primary challenge in treating osteoporosis lies in correcting the imbalance between bone resorption and formation while minimizing the associated risks of treatment. Current drugs, such as bisphosphonates, teriparatide, and romosozumab, help reduce fracture risk but have limitations, including long-term safety concerns, incomplete protection, and poor patient adherence. MAIN BODY: Exosomes, small extracellular vesicles with natural biocompatibility and low immunogenicity, have emerged as promising therapeutic candidates for osteoporosis. These vesicles carry bioactive molecules that regulate bone remodeling, promote osteogenesis, and inhibit osteoclastogenesis. Advances in bioengineering have improved the targeting efficiency and drug-loading capacity of exosomes, while their combination with biomaterials supports localized and sustained bone regeneration. The review explores the signaling mechanisms that contribute to osteoporosis and highlights the biological functions of exosomes. Furthermore, it addresses the challenges in translating exosome-based therapies, such as variability in exosome content, production standardization, scalability, and unresolved safety concerns. Preclinical models play a key role in assessing therapeutic efficacy. The review also considers interdisciplinary innovations, including nanotechnology, biomaterial...