Suppression of apoptosis in osteocytes, the potential way of natural medicine in the treatment of osteonecrosis of the femoral head

In the field of orthopedics, osteonecrosis of the femoral head (ONFH) is a common and refractory condition sometimes known as "immortal cancer" due to its complicated etiology, difficult treatment, and high disability rate. This paper's main goal is to examine the most recent literature on the pro-apoptotic effects of traditional Chinese medicine TCM monomers or compounds on osteocytes and to provide a summary of the potential signal routes. The last ten years' worth of literature on ONFH as well as the anti-ONFH effects of aqueous extracts and monomers from traditional Chinese medicine were compiled. When all the relevant signal pathways are considered, the key apoptotic routes include those mediated by the mitochondrial pathway, the MAPK signaling pathway, the PI3K/Akt signaling pathway, the Wnt/-catenin signaling pathway, the HIF-1 signaling network, etc. As a result, we anticipate that this study will shed light on the value of TCM and its constituent parts for treating ONFH by inducing apoptosis in osteocytes and offer some guidance for the future development of innovative medications as anti-ONFH medications in clinical settings.