| Steroid-induced osteonecrosis of the femoral head (SONFH) is a focal point of research in the field of orthopedic science both domestically and internationally. It is a disease with a high rate of disability. The pathogenesis of SONFH is not yet fully understood, making the exploration of its mechanism of the disease very significant. Recent studies have indicated that cell death in the femoral head caused by steroid use is closely related to the progression and outcome of SONFH. Therefore, this article reviews the relevant research advancements. The article particularly focuses on the mechanisms of action, the main types of dying cells, and potential signaling pathways of four modes of cell death, including apoptosis, autophagy, ferroptosis, and pyroptosis, in SONFH. Research has found that the use of glucocorticoids may lead to the death of various cell types (including osteoblasts, osteoclasts, bone marrow mesenchymal stem cells, chondrocytes, and endothelial cells) through the aforementioned pathways, thereby promoting the progression of SONFH. In addition, based on the theoretical guidance of bioinformatics analysis and the detection of some pyroptosis marker molecules such as NLRP3 and IL-1β, this review discusses pyroptosis as a new research direction for SONFH, which has guiding significance for its pathological mechanism and therapeutic prognosis. |