<p>Bone tissue engineering represents a promising approach to address challenges in bone defect repair by using biologically inspired alternatives to conventional grafts. Carbon nanotube (CNT)-based biomaterials have gained considerable attention owing to their superior mechanical strength, flexibility, and ability to mimic native bone properties. Despite these advantages, clinical application is limited due to concerns over cytotoxicity and biocompatibility, especially at high CNT concentrations. This review critically evaluates recent progress in three-component composites composed of CNTs, hydroxyapatite (HA), and natural polymers such as chitosan, collagen, and gelatin. Key synthesis approaches, surface modification techniques, and characterization methods are analyzed to elucidate how these composites can be engineered to optimize mechanical strength, osteoinductive capacity, and biodegradability, making them suitable for bone tissue regeneration. Emerging evidence emphasizes that surface-functionalized CNTs significantly improve cytocompatibility without compromising mechanical properties. The synergistic inclusion of HA and natural polymers further promotes osteogenic differentiation and regulates the degradation of the scaffold. This comprehensive appraisal outlines current advances, challenges, and future prospects for developing clinically viable CNT-based bone regenerative materials with balanced biological and mechanical functionalities.</p> Graphical Abstract <p></p>