Mitochondrial Transport in Bone Metabolism Homeostasis: Molecular Mechanisms and Targeted Therapeutic Strategies

The homeostasis of bone metabolism relies on the precise synergistic regulation among osteoblasts, osteoclasts, and osteocytes. Disruption of this regulatory network underlies the pathogenesis of osteoporosis, osteonecrosis, osteoarthritis, and other metabolic bone diseases. As an emerging mode of intercellular communication, mitochondrial transport delivers functional mitochondria to impaired cells, thereby reshaping cellular metabolism, alleviating oxidative stress, and restoring cell function. It thus plays an irreplaceable role in maintaining bone metabolic homeostasis. However, studies focusing on mitochondrial transport in bone metabolism are lacking, and the underlying molecular mechanisms have not been elucidated. For metabolic bone diseases, many bottlenecks exist in clinical translation. This review comprehensively summarizes the core molecular mechanism involved in mitochondrial transport, its regulatory functions in bone metabolism homeostasis, its association with metabolic bone diseases, and intervention strategies targeting mitochondrial transport. We aim to provide novel insights into the mechanism and targeted therapy of metabolic bone diseases.