Exosomes: A promising new strategy for treating osteoporosis in the future

Osteoporosis (OP) is one of the most common chronic diseases, characterized by decreased bone mass, increased bone fragility, and the destruction of bone microstructure. Current methods of treating OP face challenges, including poor therapeutic effects, obvious side effects, an inability to improve osteoblast proliferation and differentiation, and difficulty in fundamentally restoring the process of OP. Therefore, there is a need for new treatment strategies. As endogenous extracellular vesicles secreted by eukaryotic cells, exosomes participate in intercellular communication during bone remodeling. The contents of exosomes include proteins, DNA, microRNAs, etc., playing an important role in the pathogenesis of osteoporosis and osteogenesis regulation. Therefore, in this review, we emphasize the role of exosomes in the pathogenesis of osteoporosis, with a focus on their potential in reversing osteoporosis and their therapeutic efficacy. Additionally, we discuss the biological characteristics of exosomes, methods of extraction, the impact of exosomes from various sources on bone metabolism regulation, and their relevant applications. Furthermore, we explore the combination of exosomes with different bone tissue engineering materials and the latest research on the mechanisms and applications of exosome-targeted therapy for osteoporosis. Finally, the challenges and future perspectives of exosomes in the diagnosis and therapy of OP are discussed, providing important insights into the accurate clinical treatment of OP.