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Figure 6. The role of MEVs in OP. (A) EVs expressing RANK from BMSCs were designed to remodel bone homeostasis for the treatment of OP. Copyright 2024 American Chemical Society; (B) EVs derived from M2 macrophages can promote the differentiation of osteoclast precursor cells into M2 macrophages and, through the upregulation of glutamate, reduce bone resorption and enhance bone repair. Copyright 2025 Elsevier Inc; (C) The condition of skeletal muscle directly affects the quantity and functionality of the EVs secreted by it. These EVs can be endocytosed by BMSCs, promoting the glycolysis process through the delivery of LDHA and subsequently regulating osteogenic differentiation. Copyright 2023 Elsevier Inc; (D) By leveraging biominerals and EVs with bone-targeting capabilities, a multifunctional biomimetic EV system can be engineered. This system not only enhances the osteogenic differentiation of BMSCs but also demonstrates the capacity to induce angiogenesis and promote collagen mineralization. Copyright 2025 American Chemical Society. MEVs: Muscle-derived extracellular vesicles; OP: osteoporosis; EVs: extracellular vesicles; RANK: receptor activator of nuclear factor kappa-B; BMSCs: bone marrow mesenchymal stem cells; LDHA: lactate dehydrogenase A.