Exosomes are a type of tiny vesicles released by cells, which contain bioactive molecules such as proteins, nucleic acids, and lipids secreted by cells. Exosomes released by different cells play an important role in tumor development and metastasis. These exosomes can regulate the tumor microenvironment, promote the tumor growth and invasion, and participate in the process of distant metastasis by carrying specific proteins and nucleic acids. In addition, some biomarkers in exosomes can serve as potential biomarkers for early diagnosis and prognosis evaluation of osteosarcoma. This article reviews the research progress of exosomes in osteosarcoma, aiming to gain a deeper understanding of their mechanisms of action in this disease and provide a reference for the development of new treatment strategies and prognostic evaluation indicators.