Given that they can replicate both the biomechanical and mechanobiological functions of natural bone, metal additively manufactured porous load-bearing bone implants present a significant advancement in orthopedic applications. Additive manufacturing (AM) of metals enables precise control over pore geometry, resulting in implants that provide effective mechanical support and minimize stress shielding. In addition to its mechanical benefits, the porous architecture of the implants facilitates essential mechanobiological processes, including the transmission of mechanical signals that regulate cellular processes such as adhesion, proliferation, and differentiation. Before clinical use, the implants should first be engineered to achieve a comparable elastic modulus to native bone, mitigating implant-induced bone resorption while promoting tissue regeneration. It is also noteworthy that the microstructural features of these implants support angiogenesis-a critical process for oxygen and nutrient delivery during bone healing. Despite their potential benefits, challenges remain in balancing mechanical stability for load-bearing applications with biofunctionality for effective integration and controlled degradation. This review comprehensively discusses the biomechanical and mechanobiological factors influencing the design and performance of additively manufactured porous bone implants, highlighting their potential to enhance clinical outcomes in bone repair and regeneration.