The article reviews the current state and advancements in bone substitutes used in orthopedic surgery. It highlights the increasing use of bone substitutes due to the high demand for bone grafting procedures, with over two million procedures performed annually worldwide. The article discusses the limitations of autografts, such as morbidity and limited availability, and the concerns associated with allografts, including residual infectious risks and costs. Xenografts, while cheap, have shown mixed results in clinical practice. Ceramic-based synthetic bone substitutes, particularly those based on hydroxyapatite (HA) and tricalcium phosphate (TCP), are widely used and effective, despite being weaker than cortical bone. Biomimetic HAs, which contain ions that mimic natural HA, are an advanced form of traditional HA. Injectable cements enable minimally invasive techniques, and bone morphogenetic proteins (BMPs) are the only growth factors approved for human use in specific applications. Demineralized bone matrix and platelet-rich plasma (PRP) have shown limited effectiveness and are controversial. Experimental cell-based approaches, particularly the use of mesenchymal stem cells, are considered promising for bone regeneration. The article concludes by emphasizing the ongoing research and advancements in bone substitutes, highlighting the need for further clinical trials to validate emerging strategies.The article reviews the current state and advancements in bone substitutes used in orthopedic surgery. It highlights the increasing use of bone substitutes due to the high demand for bone grafting procedures, with over two million procedures performed annually worldwide. The article discusses the limitations of autografts, such as morbidity and limited availability, and the concerns associated with allografts, including residual infectious risks and costs. Xenografts, while cheap, have shown mixed results in clinical practice. Ceramic-based synthetic bone substitutes, particularly those based on hydroxyapatite (HA) and tricalcium phosphate (TCP), are widely used and effective, despite being weaker than cortical bone. Biomimetic HAs, which contain ions that mimic natural HA, are an advanced form of traditional HA. Injectable cements enable minimally invasive techniques, and bone morphogenetic proteins (BMPs) are the only growth factors approved for human use in specific applications. Demineralized bone matrix and platelet-rich plasma (PRP) have shown limited effectiveness and are controversial. Experimental cell-based approaches, particularly the use of mesenchymal stem cells, are considered promising for bone regeneration. The article concludes by emphasizing the ongoing research and advancements in bone substitutes, highlighting the need for further clinical trials to validate emerging strategies.