A significant global issue involves millions of individuals struggling with bone tissue defects. These defects, including serious conditions like osteonecrosis, arise from various factors such as fractures, tumors, trauma, and congenital disorders. Effective bone healing depends on the complex interaction between osteogenesis and the osteoimmune microenvironment. At the heart of bone regeneration are vital repair mechanisms, coordinating a series of physiological processes. These include the recruitment of inflammatory cells, the creation of vascular networks, and the development of callus tissue, followed by a later phase of remodeling. While conventional treatment options are routinely used, there has been a notable focus on alternative approaches, particularly autologous and allogeneic bone grafting. Unfortunately, the therapeutic results of these methods have often not met expectations due to limitations such as donor scarcity and graft rejection. In light of these challenges, researchers have been motivated to investigate innovative avenues for bone regeneration. This chapter begins an exploration of alternative therapeutic options, which include the use of stem and progenitor cells, the incorporation of cell-free scaffolds, and exosomes.