One of the most significant sources of cell-based therapeutics for bone tissue regeneration is mesenchymal stem cells (MSCs), and research has demonstrated that MSC-derived exosomes (MSC-Exos) can get beyond the restrictions associated with stem cell transplantation. Exosomes serve a crucial role in intercellular communication by directly influencing the transcriptional level of their target cells. They carry DNA, RNA, proteins, and lipids. Exosomes have been demonstrated to stimulate osteogenesis and osteogenic differentiation in the bone microenvironment both in vivo and in vitro. MSC-Exos have advanced significantly in bone regeneration and repair recently. This article addresses the formation of MSC-Exos, their application, and possible therapeutic procedures in the restoration of bone tissue defects.