Abstract:[Objective] To further verify whether icariin (ICA) regulate the expression imbalance of mirNA-23B in hormone-induced femoral head bone microvascular endothelial cells (BMECs) , protect the function of BMECs, and prevent the occurrence of hormone-in- duced osteonecrosis of femoral head (ONFH) . [Methods] Ninety female SD rats were randomly assigned to three groups with 30 animals in each group. The animals in the model group were given high dose of methylprednisolone with lipopolysaccharide to establish femoral head necrosis model, and were gavaged with normal saline. Those in the ICA group were given the drugs as the model group, and were simultane- ously gavaged with ICA 60 mg/kg · d-1 intragastrically for 4 weeks. However, the rats in the blank group only received the same amount of normal saline. At 4 weeks, the femoral heads were harvested for histological examination. In addition, BMECs were isolated from the femo- ral heads for identification, detection of apoptosis and bioinformatics analysis of miRNA- 23B expression. [Results] In term of histomor- phometry, the width and area of trabecular bone in the model group were significantly lower than those in blank group and ICA group (P< 0.05) , while which was not significantl different between blank group and ICA group (P>0.05) . The ratio of empty bone lacunae in model group was significantly higher than that in ICA group and blank group (P<0.05) . In terms of cell apoptosis, the active cell ratios of BMECs were ranked from high to low: the blank group > the ICA group > the model group (P<0.05) , which in the model group was significantly low- er than the blank group and ICA group (P<0.05) , while there was no significant difference between blank group and ICA group (P>0.05) . Conversely, the ratios of early apoptotic cells from high to low was: the model group > the ICA group > the blank group (P<0.05) , in which the model group was significantly higher than the control group (P<0.05) , whereas there was no a significant difference between blank group and ICA group (P>0.05) . As results of bioinformation analysis, mirNA-23B expression was down-regulated significantly in the mod- el group compared with that in the blank group (P<0.05) , but there was no a significant difference between the ICA group and the blank group (P>0.05) . [Conclusion] The ICA does effectively prevent the occurrence of steroid-induced ONFH and protect BMECs in this ani- mal models, in which the mirNA-23B in BMECs may be the target of ICA to prevent steroid-induced ONFH.