Steroid-induced avascular necrosis of the femoral head (SANFH) is a metabolic disease that occurs due to improper clinical use of glucocorticoid. The blood supply system inside the femoral head is impaired and the tissue components of bone cells and bone mar- row die, which may lead to structural changes of the femoral head, collapse of the femoral head and joint dysfunction. SANFH in adults is a challenging orthopedic disorder due to collapse of the femoral head in the end-stage with hip dysfunction eventually, which seriously com- promises the patient's quality of daily life, and will need total hip replacement, however, the pathogenesis of the disease remains unclear. In recent years, exact pathogenesis of SANFH and more new treatments for it are conducting with the further development of precision medi- cine and extensive and in- depth research on stem cells and molecular biology. This review discusses several leading theories about the pathogenesis of SANFH.