The effect of bone marrow mesenchymal stem cell-derived extracellular vesicles on bone mineral density and microstructure in osteoporosis: A systematic review and meta-analysis of preclinical studies

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Objective The treatment of osteoporosis is challenged by limited bone regeneration and side effects. Bone marrow mesenchymal stem cell-derived extracellular vesicles (BMSC-EVs) have gained widespread attention as a potential therapeutic approach. This study aims to evaluate the effects of BMSC-EVs on bone density, trabecular microstructure, and biomechanical properties in animal models of osteoporosis, providing evidence to support clinical translation and mechanism exploration. Methods A systematic search was conducted in the PubMed, Cochrane, Web of Science, and Embase (inception to January 2025) databases for preclinical studies on BMSC-EV intervention in osteoporosis models. A random-effects model was used to synthesize and analyze seven key parameters (BMD, BV/TV, Tb.N, Tb.Sp, Tb.Th, Ct.Th, and ultimate load-bearing capacity). Subgroup analysis was performed based on species (rats/mice), EVs engineering targets/methods, injection frequency, and treatment duration. The quality of the studies was assessed using SYRCLE's risk of bias tool. Results The meta-analysis of 10 studies (355 animals) showed that, compared to the control group, BMSC-EV treatment significantly increased BMD, BV/TV, Tb.N, Tb.Th, Ct.Th, and ultimate load-bearing capacity, while reducing Tb.Sp in the osteoporosis model. A publication bias was found in the summary analysis for Tb.N. However, sensitivity an

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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