From mechanisms to clinical applications: A bibliometric analysis of extracellular vesicles in osteoporosis (2013–2025)

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Background Osteoporosis (OP) poses a significant and growing global health burden. Extracellular Vesicles (EVs), as pivotal mediators of intercellular communication, offer transformative potential for OP therapy. However, the rapid expansion of this interdisciplinary field has resulted in a fragmented knowledge structure. While existing reviews focus on specific molecular mechanisms, a macroscopic, quantitative analysis of the global research landscape—from biological fundamentals to bioengineering applications—is lacking. Objective This study aims to provide a comprehensive bibliometric mapping of EV research in OP (2013–2025), decoding the paradigm shift from mechanistic exploration to precision engineering and identifying emerging frontiers. Methods Based on 450 publications retrieved from the Web of Science Core Collection, a multi-algorithm approach integrating Bibliometrix, VOSviewer, and CiteSpace was employed. This allowed for the visualization of global collaboration networks, intellectual bases, and dynamic evolutionary trends. Results The field exhibited a distinct "S-shaped" growth curve, entering an exponential phase post-2021. Geopolitically, China dominated the landscape (79.3% of publications) and served as the indispensable global network hub (Betweenness Centrality = 1.00), despite a high degree of domestic research focus (Single-Country Publications: 93.6%). Intellectual progress has shifted from early-stage themes of "miRNA regulation" to a current "Med-Engineering-Biology" convergence. The most significant frontiers include: ( 1 ) The application of plant-derived EVs (e.g., yam nanovesicles) as novel therapeutic agents; ( 2 ) The development of smart biomaterials (e.g., hydrogels) for sustained delivery; and ( 3 ) The transition from natural carriers to engineered precision therapeutics for bone regeneration. Conclusion EV research in OP is evolving beyond cell biology into a multidisciplinary engineering science. Future breakthroughs hinge on overcoming translational bottlenecks—specifically standardization and targeting efficiency—through the continued integration of nanotechnology, materials science, and clinical medicine. Plain Language Summary Osteoporosis (OP) is a growing global health burden affecting hundreds of millions of people. Extracellular vesicles (EVs), acting as natural messengers between cells, have shown revolutionary potential in regulating bone metabolism and treating OP. To clarify the fragmented knowledge structure of this rapidly expanding field, we conducted a bibliometric analysis of 450 studies published between 2013 and 2025. Our analysis reveals a shift from "biological mechanism" to "bioengineering application." While early research focused on basic cellular signaling (e.g., miRNAs), the current frontier is defined by engineering strategies—specifically, the use of plant-derived EVs (e.g., from yams) and smart biomaterials (e.g., hydrogels) for targeted bone repair. Geopolitically, China dominates the research landscape (contributing 79.3% of publications) and serves as the global network hub; however, international collaboration remains limited. This study provides a roadmap for future research, highlighting that the clinical translation of EV-based therapies depends on standardizing isolation protocols and enhancing global interdisciplinary cooperation.