Objective To further verify whether icariin (ICA) can effectively regulate the imbalance of miRNA-23b expression induced by glucocorticoids in femoral head bone microvascular endothelial cells (BMECs), protect the function of BMECs, and prevent the occurrence of steriod-induced osteonecrosis of femoral head(ONFH). Methods 90 female SD rats were divided into three groups: Model group (MPS)、Model +ICA group(MPS+ICA) and Control group. After modeling and interventions were completed, the femoral heads of 10 rats in each group were randomly selected for HE staining, and the percentage of bone trabecular area, width of bone trabecular and rate of hollow bone lacunae per unit area were calculated; BMECs were identified; the BMECs samples of 3 rats in each group were taken for bioinformatics analysis, and the expression of miRNA-23b in three groups were extracted and miRNA-23b regulatory target genes was performed using Gene Ontology (GO) software. BMECs apoptosis of 15 rats in each group were detected by flow cytometry. Results The percentage of bone trabecular area per unit area and width of trabecular in MPS group was significantly lower than that in control group (P<0.05), and there was no significant difference between MPS+ICA group and control group (P>0.05).The rate of empty lacunae in MPS group was significantly higher than that in MPS+ICA group (P<0.05). The purity of BMECs was 99%. The expression of miRNA-23b in MPS+ICA group(FC=-1.00) was higher than MPS group(FC=-2.08). There were statistically significant differences between the percentage of living BMECs cells and the percentage of early apoptotic cells in the three groups (P<0.05). Conclusion ICA can effectively prevent the occurrence of steriod-induced ONFH in animals and protect BMECs at the same time. miRNA -23b in BMECs may be the target of ICA in preventing hormone-induced ONFH.