Glucocorticoid, as one of the main non-traumatic causes of femoral head necrosis, is still a complex and refractory disease, and the corresponding mechanism is not clear at present.Previously, mechanisms such as impaired blood supply, endothelial injury, coagulation disorders, thrombosis, abnormal lipid metabolism and cell apoptosis were thought to play important roles. In recent years, small non-coding RNAs and genetic susceptibility have been found to play an important role in the mechanism of femur head necrosis,and increasing numbers of signaling pathways and cytokines in the disease are revealed, it is hoped that we can reverse the adverse effects of a mechanism on the femoral head by intervening in one or more of the interacting processes in the disease. This paper mainly summarized the pathophysiological mechanism of ONFH caused by corticosteroid use in common etiology, providing theoretical basis for future research and treatment of steroid-induced femoral head necrosis.