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In musculoskeletal medicine, they address diverse pathological processes—including inflammation, degeneration, infection, oncology, and fibrosis—through mechanisms that conventional therapeutics cannot replicate.

Two principal frameworks underpin this field.

Throughout this review, we differentiate bioactive peptides, defined as naturally occurring or food-derived sequences that exert physiological effects, from therapeutic peptides, which are purposefully engineered pharmaceutical agents intended for clinical application.

Although conceptual and functional overlap exists, this distinction is important because the two categories are subject to different regulatory pathways and evidentiary requirements.

Accordingly, peptides discussed in this review fall into two broad groups: first, bioactive peptides originating from food proteins, endogenous biological systems, or laboratory synthesis, typically comprising 2– 50 amino acids; and second, therapeutic peptides that are rationally designed to address traditional limitations of peptide-based agents, including proteolytic degradation and challenges related to stability, bioavailability, and delivery.

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