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.)