• miRNAs are key post-transcriptional regulators that play a crucial role in osteoporosis pathogenesis by modulating osteoblast, osteoclast, and angiogenesis functions.
• miRNA-based therapies face major challenges including poor in vivo stability and off-target effects, hindering clinical translation.
• Strategies such as chemical modification, targeted gene selection, and advanced delivery systems (viral vectors, exosomes, biomaterials) are being developed to overcome these barriers.
• Future innovations in nucleic acid drug carriers aim to achieve precise and efficient delivery for effective osteoporosis treatment.