Abstract
Osteoporotic fractures represent a significant public health challenge in the context of an aging global population, with the rising prevalence of osteoporosis intensifying the demand for effective fracture treatment. Restoring the structure and function of bone tissue damaged by osteoporosis-induced defects remains a critical issue in clinical practice. In recent years, bioactive metallic materials such as magnesium, zinc, and strontium have gained considerable attention due to their exceptional mechanical properties, biocompatibility, and biodegradability, positioning them as promising materials for osteoporotic fracture repair. This review systematically explored the biological mechanisms, application advancements, and associated challenges of magnesium, zinc, and strontium in fracture healing. Key topics included their roles in promoting osteoblast proliferation and differentiation, inhibiting osteoclast activity, and modulating the bone microenvironment. Additionally, this review examined the optimization strategies for their clinical application, such as their integration into bone scaffolds, the functionalization of conventional materials, and the synergistic effects between different metals. Finally, this review analyzed the current progress and unresolved issues in this field, offering a forward-looking perspective on the clinical potential of bioactive metallic materials in precision treatment of osteoporotic fractures.