• Exosomes mediate critical intercellular and inter-organ communication in bone biology, influencing bone remodeling, regeneration, and skeletal homeostasis.
• Dysregulation of exosome-mediated pathways contributes to the pathogenesis of major bone diseases, including osteoporosis, osteoarthritis, osteonecrosis of the femoral head, and bone metastases.
• Exosomes hold promise as biomarkers, therapeutic agents, and drug delivery vehicles for bone diseases, with potential for precision medicine applications.
• Artificial intelligence is emerging as a powerful tool in exosome research, aiding in biomarker discovery, disease classification, and target identification, though challenges remain for clinical translation.