Abstract: BACKGROUND: In recent years, there have been many studies on the prevention and treatment of femoral head necrosis with traditional Chinese medicine. A variety of single Chinese medicines, Chinese medicine monomers and Chinese medicine compounds can regulate bone metabolism, lipid metabolism, and oxidative stress by targeting signaling molecules. The prevention and treatment of femoral head necrosis by translation-related signaling pathways has become a research hotspot.
OBJECTIVE: To expound the global research progress in hormone-induced femoral head necrosis treated with Chinese medicine, in order to provide some ideas for the treatment of hormone-induced femoral head necrosis.
METHODS: CNKI, WanFang, VIP, SinoMed, PubMed, Embase, and Web of Science databases were searched with the search terms “glucocorticoids, avascular necrosis of the femoral head, ANFH, pathogenesis, signal path, Chinese medicine compound, oxidative stress” in Chinese and English. Literature was retrieved on Chinese medicine compounds and active ingredients for intervention of the signaling pathway related to hormone-induced femoral head necrosis. A total of 71 documents were included according to the inclusion and exclusion criteria.
RESULTS AND CONCLUSION: Chinese medicine may treat hormone-induced femoral head necrosis through multiple signaling pathways. Total saponins of Panax notoginseng, total flavonoids of Rhizoma Drynariae, and resveratrol glucoside promote osteoblast proliferation and differentiation and inhibit osteoclast formation by regulating the level of β-catenin protein and the formation of β-catenin-TCF/LEF complex via the Wnt/β-catenin signaling pathway. Recipes for invigorating blood and reinforcing marrow, warming yang and tonifying kidney, and relieving bone bi-syndrome maintain osteoblast-osteoclast dynamic balance and bone homeostasis by regulating the OPG/RANK/RANKL pathway. Puerarin, salidroside, allicin, and icariin influence the proliferation and apoptosis of osseous cells and angiogenesis of microvascular endothelial cells in the femoral head via the PI3K/Akt signaling pathway. Ginsenosides can down-regulate the expressions of superoxide dismutase and catalase by interfering with the Keapl-Nrf2-ARE signaling pathway, thereby attenuating oxidative stress damage. Gastrodin, lutein, and astragaloside IV can promote the proliferation and differentiation of osteoblasts by intervening Nrf2/HO-1 signaling, thereby improving the level of oxidative substances. Naringin and polygonin balance the osteogenic/adipogenic differentiation of bone marrow mesenchymal stem cells via the Nrf2/ARE signaling pathway. Traditional Chinese medicine can regulate oxidative stress response of osteocytes, which is another important way to treat hormone-induced necrosis of the femoral head.

Key words: Chinese medicine compound, bone metabolism, lipid metabolism, bone marrow mesenchymal stem cell, osteoblast, osteoclast, oxidative stress, signaling pathway, review