Exosomes in bone health and disease: cellular crosstalk, systemic signaling, and AI-driven advances in regenerative therapy

• Exosomes are key mediators of intercellular and inter-organ communication in bone biology, carrying diverse molecular cargos that regulate bone remodeling and homeostasis. • Exosome-mediated signaling is disrupted in bone diseases such as osteoporosis, osteoarthritis, and osteonecrosis, highlighting their potential as biomarkers and therapeutic targets. • Artificial intelligence is emerging as a powerful tool in exosome research, aiding in biomarker discovery, disease classification, and target identification for precision medicine. • Exosome-based strategies hold promise for regenerative therapy and drug delivery, but clinical translation faces challenges such as standardization and scalability.