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In bone metastasis, tumor\u2010derived exosomes (TDEs) play a crucial role in the establishment of pre\u2010metastatic niches, modulation of osteoclast\u2013osteoblast balance, and promotion of tumor cell colonization through the transfer of bioactive molecules such as proteins, lipids, and non\u2010coding RNAs. Conversely, in bone tissue engineering, stem cell\u2010derived exosomes have demonstrated remarkable potential to promote osteogenesis, angiogenesis, and tissue regeneration by activating signaling pathways that regulate bone remodeling. This dual role of exosomes\u2014as drivers of disease progression and as therapeutic agents\u2014highlights their significance as both diagnostic biomarkers and next\u2010generation biologics. This review provides a comprehensive overview of the molecular mechanisms underlying exosome\u2010mediated communication in bone metastasis and bone regeneration, summarizes recent advances in exosome\u2010engineered biomaterials, and discusses the translational challenges that must be addressed to enable clinical applications. Understanding the multifaceted functions of exosomes will pave the way for the development of novel exosome\u2010based strategies for the diagnosis and treatment of bone\u2010related diseases.<\/jats:p>","DOI":"10.1002\/biot.70257","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T08:05:57Z","timestamp":1780992357000},"source":"Crossref","is-referenced-by-count":1,"title":["The Role of Exosomes in Bone Metastasis and Bone Tissue Engineering: Molecular Mechanisms and Therapeutic Opportunities"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3560-9169","authenticated-orcid":false,"given":"Asrin","family":"Emami","sequence":"first","affiliation":[{"name":"Iranian Tissue Bank and Research Center Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5511-1512","authenticated-orcid":false,"given":"Iman 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