Exosomes in Metabolic Bone Diseases: Regulators, Biomarkers and Targeted Delivery Systems
Abstract
Background: Metabolic bone diseases represent prevalent global disorders characterized by disrupted bone homeostasis and chronic inflammation. This review utilizes a broad working definition encompassing osteoporosis and other classic metabolic bone disorders, including osteoarthritis, a primarily degenerative joint disease marked by significant metabolic-driven subchondral bone remodeling. Conventional diagnostic modalities prove inadequate for early-stage disease screening, while classical pharmacological interventions face limitations due to unsatisfactory targeting performance and severe long-term adverse reactions. An urgent clinical need persists for innovative diagnostic biomarkers and targeted therapeutic strategies. Exosomes, a sub-population of small extracellular vesicles (sEVs), are natural nanoscale intercellular vesicles derived from multivesicular bodies, playing critical regulatory roles in bone metabolism and offering substantial clinical translational potential. This review systematically elaborates the regulatory networks associated with exosomes, the biomarker potential of exosomal non-coding RNAs, and advanced engineering modifications for bone-targeted delivery in metabolic bone diseases. Methods: This narrative review involved a literature search conducted across PubMed, Web of Science, Scopus, and Embase from inception to December 2025, focusing on exosome biology, metabolic bone disorders, non-coding RNA biomarkers, and engineered bone-targeted…
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