Exendin-4 is an analogue of glucagon-like peptide-1 (GLP-1) and has a good efficacy in the treatment of type Ⅱ diabetes. Recently, some researchers have found that Exendin-4 can promote cell osteogenesis and angiogenesis, but the specific mechanism of its promotion of bone regeneration is not yet clear. This review focuses on the specific mechanisms by which Exendin-4 promotes osteogenesis in bone cells and stem cells, as well as its ability to induce endothelial cell migration, budding, and neovascularization, and promote angiogenesis. In addition, this article discusses some in vivo experiments using Exendin-4 alone or in combination with other materials. However, since its specific mechanism is not yet clear, and there is no clinical data to support it, a comprehensive understanding of the mechanism by which Exendin-4 promotes bone regeneration is of significant value for treatment of bone tissue damage in diabetic patients. This review also provides a certain direction and basis for the subsequent practical application of Exendin-4.