This review discusses the development of bioactive composite 3D scaffolds for bone tissue engineering (BTE). Bone is the second most commonly transplanted tissue globally, with over four million operations annually using bone grafts or substitutes. However, current treatments face limitations due to conditions like trauma, cancer, infection, and arthritis. Developing bioactive 3D scaffolds that support bone regeneration is a key focus in BTE. Various materials and methods, including 3D printing, have been used to create alternatives to traditional bone grafts. However, individual materials like polymers, ceramics, and hydrogels have not fully replicated bone properties when used alone. Combining materials in composite 3D scaffolds can improve bioactivity and structural biomimicry. The review examines recent use of polymers, hydrogels, metals, ceramics, and bio-glasses in BTE. Scaffold fabrication methods, mechanical performance, biocompatibility, bioactivity, and clinical translation are discussed. Ideal scaffold properties include biocompatibility, biodegradability, mechanical strength, porosity, and surface properties. Scaffold microarchitecture is also important for cell viability and tissue ingrowth. Scaffold fabrication methods include solvent casting/particulate leaching, gas foaming, freeze-drying, phase separation, electrospinning, and 3D printing. 3D printing techniques such as stereolithography, fused deposition modelling, and selective laser sintering have improved scaffold precision and repeatability. 3D bioprinting offers a potential solution for creating complex tissue constructs with living cells and biomaterials. Materials used in BTE include metals, ceramics, polymers, hydrogels, and composites. Metals like cobalt-chromium, titanium, and stainless steel have good biocompatibility and strength but lack biodegradability. Bioceramics such as calcium phosphates and bioactive glasses have favorable bioactivity and mechanical properties. Bioactive glasses (BGs) are a subgroup of ceramic materials with strong osteoconductivity and bioactivity. BGs can be combined with biodegradable polymers to improve properties like porosity and degradation rate. 3D bioprinting techniques such as inkjet, laser-assisted, microvalve, and extrusion bioprinting have been used to create scaffolds with living cells and biomaterials. The review highlights the potential of bioactive composite 3D scaffolds in BTE, with a focus on improving bone regeneration and clinical translation.This review discusses the development of bioactive composite 3D scaffolds for bone tissue engineering (BTE). Bone is the second most commonly transplanted tissue globally, with over four million operations annually using bone grafts or substitutes. However, current treatments face limitations due to conditions like trauma, cancer, infection, and arthritis. Developing bioactive 3D scaffolds that support bone regeneration is a key focus in BTE. Various materials and methods, including 3D printing, have been used to create alternatives to traditional bone grafts. However, individual materials like polymers, ceramics, and hydrogels have not fully replicated bone properties when used alone. Combining materials in composite 3D scaffolds can improve bioactivity and structural biomimicry. The review examines recent use of polymers, hydrogels, metals, ceramics, and bio-glasses in BTE. Scaffold fabrication methods, mechanical performance, biocompatibility, bioactivity, and clinical translation are discussed. Ideal scaffold properties include biocompatibility, biodegradability, mechanical strength, porosity, and surface properties. Scaffold microarchitecture is also important for cell viability and tissue ingrowth. Scaffold fabrication methods include solvent casting/particulate leaching, gas foaming, freeze-drying, phase separation, electrospinning, and 3D printing. 3D printing techniques such as stereolithography, fused deposition modelling, and selective laser sintering have improved scaffold precision and repeatability. 3D bioprinting offers a potential solution for creating complex tissue constructs with living cells and biomaterials. Materials used in BTE include metals, ceramics, polymers, hydrogels, and composites. Metals like cobalt-chromium, titanium, and stainless steel have good biocompatibility and strength but lack biodegradability. Bioceramics such as calcium phosphates and bioactive glasses have favorable bioactivity and mechanical properties. Bioactive glasses (BGs) are a subgroup of ceramic materials with strong osteoconductivity and bioactivity. BGs can be combined with biodegradable polymers to improve properties like porosity and degradation rate. 3D bioprinting techniques such as inkjet, laser-assisted, microvalve, and extrusion bioprinting have been used to create scaffolds with living cells and biomaterials. The review highlights the potential of bioactive composite 3D scaffolds in BTE, with a focus on improving bone regeneration and clinical translation.