Abstract: Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disorder. In recent years, the incidence of ONFH has increased dramatically due to changing lifestyles and accelerated population aging, making it a major skeletal disease affecting human health. Studies have demonstrated that ⁹⁹Tc^m-MDP bone scintigraphy plays a significant role in the early diagnosis, staging, progression prediction, and therapeutic evaluation of ONFH. Additionally, the domestically produced agent ⁹⁹Tc-MDP has been shown to delay disease progression, alleviate symptoms, and improve quality of life in patients with ONFH. The authors reviewed recent research advancements regarding the application of ⁹⁹Tc^m-MDP bone scintigraphy and ⁹⁹Tc-MDP targeted therapy for ONFH, aiming to provide reliable scientific evidence and clinical guidance for precise diagnosis and treatment of this disease.