The central challenge in bone tissue engineering is not merely to fabricate bone-like materials, but to reconstruct a regenerative microenvironment that recapitulates native bone. Decellularized extracellular matrix (dECM) retains tissue-specific structural components and biological cues and is therefore regarded as a promising biomaterial for bone regeneration. However, its poor mechanical strength, structural instability, and limited printability restrict its application in complex bone defects. Recent advances in bioprinting, together with chemical modification, bioactive substance incorporation, and biomimetic structural design, have provided new opportunities to improve the osteogenic and functional properties of dECM-based constructs. This review first outlines the major biological processes involved in bone repair and introduces the principal bioprinting technologies and dECM sources relevant to bone tissue engineering. It then discusses recent strategies for optimising dECM sources and processing methods, modifying material properties, incorporating bioactive substances, and constructing biomimetic architectures. Particular attention is given to how these approaches promote osteogenesis, vascularisation, and functional bone reconstruction. Current limitations and future directions for clinical translation are also considered. By integrating bone repair processes, dECM characteristics, bioprinting technologies, and functional enhancement strategies, this review clarifies how advanced bioprinting can improve the regenerative performance of dECM and guide the development of next-generation functional materials for bone defect repair.