Tumor–Bone Crosstalk in Nasopharyngeal Carcinoma Bone Metastasis: Organotropic Dissemination, Osteolytic Niche Remodeling, and Translational Therapeutic Opportunities

Bone metastasis is a clinically significant complication of nasopharyngeal carcinoma (NPC), closely associated with skeletal‐related events, treatment resistance, and poor prognosis. Although NPC metastasis has been widely investigated in the context of Epstein–Barr virus infection, immune escape, and distant dissemination, the mechanisms that govern skeletal colonization and bone microenvironment remodeling remain insufficiently defined. Current evidence suggests that NPC bone metastasis is an active and selective process shaped by reciprocal interactions between disseminated tumor cells and the bone marrow niche. In this review, we summarize the clinical burden of NPC bone metastasis and discuss the biological basis of skeletal organotropism, pre‐metastatic niche formation, osteolytic remodeling, immune suppression, metabolic adaptation, extracellular vesicle‐mediated communication, and therapeutic resistance. Particular emphasis is placed on the crosstalk among NPC cells, osteoclasts, osteoblast‐lineage cells, stromal cells, endothelial niches, immune populations, extracellular matrix components, and circulating tumor‐derived factors. We also discuss translational opportunities, including improved risk prediction, molecular and imaging biomarkers, bone‐targeted therapy, radiotherapy optimization, and rational combination strategies. A clearer understanding of tumor and bone crosstalk may help guide earlier detection, more precise intervention, and better outcomes for patients with bone‐metastatic NPC.