Functionalizing biomaterials for osseointegration – microRNAs at the crossroads of bone formation and immune modulation

MicroRNAs (miRNAs) play an important role in post-transcriptional gene regulation by binding to messenger RNA and thereby modulating protein synthesis and affecting cellular functions such as proliferation and apoptosis. In bone biology, miRNAs influence osseointegration, a process vital to the long-term success of orthopaedic implants. This process involves coordinated phases of inflammation, bone formation, and remodelling, which are regulated by miRNA-mediated signalling networks. miRNAs contribute to the regulation of osteoblast and osteoclast activity, as well as macrophage-mediated immune responses, thereby influencing bone regeneration and integration with implant surfaces. This review summarizes current insights into the role of miRNAs at the bone–implant interface, focusing particularly on their involvement in immune modulation and bone tissue formation. Furthermore, it explores emerging strategies for the local delivery of miRNAs to enhance implant integration, highlighting their therapeutic potential in improving orthopaedic outcomes. Cite this article: Bone Joint Res 2026;15(7):864–879.