<p>Copper-based metal organic frameworks (Cu-MOFs) represent a highly versatile family of porous crystalline materials valued for their tunable structures, redox-active Cu centers, and inherent biodegradability, which collectively increase their therapeutic and technological potential. This review provides an integrated overview of recent progress in synthetic approaches ranging from solvothermal and mechanochemical techniques to more sustainable, scalable green processes and emphasizes how precise control over coordination chemistry, defect formation, and surface engineering governs their physicochemical performance. Major biomedical advancements are highlighted, particularly their role as both drug delivery platforms and active therapeutic agents capable of generating reactive oxygen species for chemodynamic therapy, supporting synergistic phototherapies, and exerting antimicrobial effects, with innovations in stimuli-responsive designs and biomimetic modifications improving stability and targeting under physiological conditions. Additionally, the increasing importance of Cu-MOFs in catalysis, energy storage, and environmental remediation underscores their wide-ranging industrial significance. Nonetheless, challenges such as ensuring long-term biosafety, maintaining stability in biological environments, and achieving reproducible large-scale production continue to limit clinical translation. Future progress will rely on predictive design tools, deeper structure–function understanding, and standardized biological assessments. Overall, Cu-MOFs stand at the interface of materials science and biomedicine, with ongoing innovations poised to drive their evolution from promising laboratory systems into impactful real-world applications.</p> Graphical abstract <p></p>