• Longyu Li, Shangkun Zhao, Zikuan Leng, Songfeng Chen, Yifang Shi, Lijun Shi, Jinfeng Li, Keya Mao, Hai Tang, Bin Meng, Yisheng Wang, Guowei Shang, and Hongjian Liu.
• Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
• Ann. Med. 2024 Dec 1; 56 (1): 24160702416070.

BackgroundOsteonecrosis of the femoral head (ONFH) is a refractory orthopedic disease with a high disability rate. Long-term administration of steroids is the most common pathogenic factor for non-traumatic ONFH. Early diagnosis of steroid-induced osteonecrosis of the femoral head (SONFH) is difficult and mainly depends on imaging.ObjectivesThe objectives of this review were to examine the pathological mechanisms of SONFH, summarize related markers of SONFH, and identify areas for future studies.MethodsWe reviewed studies on pathological mechanisms and related markers of SONFH and discussed the relationship between them, as well as clinical applications and the outlook of potential markers.ResultsThe pathological mechanisms of SONFH included decreased osteogenesis, lipid accumulation, increased intraosseous pressure, and microcirculation disruption. Differential proteomics and genomics play crucial roles in the occurrence, progression, and outcome of SONFH, providing novel insights into SONFH. Additionally, the biological functions of mesenchymal stem cells (MSCs) and exosomes (Exos) in SONFH have attracted increasing attention.ConclusionsThe pathological mechanisms of SONFH are complex. The related markers mentioned in the current review can predict the occurrence and progression of SONFH, which will help provide effective early clinical prevention and treatment strategies for SONFH.

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