Panoramic description of ROS-based nanotechnology for osteomyelitis therapy: Challenges, opportunities, and prospects

Osteomyelitis, an inflammatory disease of bone and bone marrow caused by infectious microorganisms, has long been a major clinical challenge due to the lack of consistently effective treatment strategies. Conventional therapeutic approaches, such as antibiotic therapy and surgical debridement, are frequently associated with the development of antibiotic resistance and a high risk of disease recurrence, thereby complicating long-term clinical management. In recent years, reactive oxygen species (ROS)-based nanotechnology has emerged as a promising therapeutic modality for osteomyelitis, garnering considerable attention for the potential to overcome antibiotic resistance. This review summarizes the epidemiological characteristics, current treatment approaches, and pathogenic mechanisms of osteomyelitis, and comprehensively examines advances in ROS nanotechnologies for osteomyelitis treatment. In addition, the technical advantages and limitations of major ROS-based strategies, including photodynamic therapy (PDT), sonodynamic therapy (SDT), chemodynamic therapy (CDT), and microwave dynamic therapy (MWDT), are systematically discussed to provide guidance for further optimization of ROS-mediated strategies. Furthermore, the therapeutic potential of these strategies in antimicrobial activity, promotion of tissue repair, and immune regulation is analyzed, offering theoretical support for the integration of ROS-based strategies with existing treatment modalities for improved management of osteomyelitis.