Osteoporosis is a widely observed condition characterized by the systemic deterioration of bone mass and microarchitecture, which increases patient susceptibility to fragile fractures. The intricate mechanisms governing bone homeostasis are substantially impacted by extracellular vesicles (EVs), which play crucial roles in both pathological and physiological contexts. EVs derived from various sources exert distinct effects on osteoporosis. Specifically, EVs released by osteoblasts, endothelial cells, myocytes, and mesenchymal stem cells contribute to bone formation due to their unique cargo of proteins, miRNAs, and cytokines. Conversely, EVs secreted by osteoclasts and immune cells promote bone resorption and inhibit bone formation. Furthermore, the use of EVs as therapeutic modalities or biomaterials for diagnosing and managing osteoporosis is promising. Here, we review the current understanding of the impact of EVs on bone homeostasis, including the classification and biogenesis of EVs and the intricate regulatory mechanisms of EVs in osteoporosis. Furthermore, we present an overview of the latest research progress on diagnosing and treating osteoporosis by using EVs. Finally, we discuss the challenges and prospects of translational research on the use of EVs in osteoporosis.

骨质疏松症是一种广泛观察到的疾病，其特征是骨量和微结构的全身恶化，这增加了患者对脆性骨折的易感性。控制骨稳态的复杂机制受到细胞外囊泡 （EVs） 的重大影响，细胞外囊泡在病理和生理环境中都起着至关重要的作用。来自各种来源的 EV 对骨质疏松症产生不同的影响。具体来说，成骨细胞、内皮细胞、肌细胞和间充质干细胞释放的 EV 由于其独特的蛋白质、miRNA 和细胞因子载体而有助于骨骼形成。相反，破骨细胞和免疫细胞分泌的 EV 促进骨吸收并抑制骨形成。此外，使用 EV 作为诊断和管理骨质疏松症的治疗方式或生物材料是有前途的。在这里，我们回顾了目前对 EV 对骨稳态影响的理解，包括 EV 的分类和生物发生以及 EV 在骨质疏松症中错综复杂的调节机制。此外，我们概述了使用 EV 诊断和治疗骨质疏松症的最新研究进展。最后，我们讨论了 EV 在骨质疏松症中的应用转化研究的挑战和前景。