I run HA OS and from my experience updating and installing add-ons is seamless.
Creating backups and restoring (had to replace a corrupt SD Card a while ago) was also no issue.
Add-ons I have installed
Advanced SSH Terminal
ESP Home
Home Assistant Google Drive Backup
VS Code Server
Maria DB
HACS for a few integrations:
YT Music Player
Waste Collection Schedule
nothing too fancy.
I run a second Pi with an SSD for docker containers or native OS installs (gitea, drone-ci, pi-hole, etc.)