Advances in Research on Autophagy in Steroid-Induced Osteonecrosis of the Femoral Head: Dual Regulation of Its Beneficial and Detrimental Effects.

Steroid-induced osteonecrosis of the femoral head (SONFH) is a common and refractory clinical condition with a complex pathogenesis that remains incompletely understood. As a highly conserved intracellular degradation and recycling pathway, autophagy plays a dual regulatory role in the pathological process of SONFH: moderate activation of autophagy exerts protective effects by clearing damaged organelles and maintaining cellular homeostasis; conversely, excessive or dysfunctional autophagy aggravates cell injury and bone tissue destruction. This narrative review systematically summarizes the dynamics, mechanisms, and regulatory networks of autophagy in SONFH from the perspectives of both beneficial and detrimental autophagy, providing references for a deeper understanding of SONFH and the development of targeted therapies. Furthermore, we explore therapeutic strategies based on the dual nature of autophagy, including precise pharmacological modulation, restoration of autophagic-lysosomal function, combined treatment approaches, and the application of novel biomaterials and targeted delivery systems. By integrating current mechanistic insights and proposing stage-specific regulatory strategies, this review highlights the translational potential of autophagy modulation in SONFH and provides a theoretical foundation for future clinical interventions.