Adipose-derived mesenchymal stem cells (ADMSCs) are a kind of multipotent stem cells which are isolated from the adipose tissue. They can induce the differentiation of osteoblasts under certain treatment, and are important in the repair of osseous tissue. Research has found that ADMSCs can induce the differentiation of MSCs in the direction of osteogenesis by secreting cytokines and extracellular vesicles and activating GF-β/BMPs, Wnt and other signaling pathways. Research has also found that applying ADMSCs and their extracellular vesicles to the clinical treatment of osteoporosis has low extraction cost, high safety and good application prospect, compared with bone marrow-derived mesenchymal stem cells. This review intends to summarize the major patterns and molecular mechanisms of ADMSCs in inducing osteogenic differentiation and further discusses the advantages and prospects of applying ADMSCs and their extracellular vesicles to the clinical treatment of osteoporosis.