In recent years, metal-organic frameworks (MOFs) have been widely used in the field of pharmaceuticals, and their stable structure and chemical properties have shown great potential in applications requiring drug delivery carriers. ZIF-90, as a new type of MOF, has gradually attracted more attention in the field of biological medicine. ZIF-90 has the advantages of a large specific surface area, a uniform pore structure, and good biocompatibility. Importantly, the specific pH/ATP sensitivity and mitochondrial targeting provide an opportunity for it to become an intelligent drug delivery system. But unfortunately, there are few specialized reviews with a focus on ZIF-90. This article not only summarizes the structure, characterization, synthesis and biosecurity of ZIF-90, but also discusses the research progress using it as a therapeutic platform in anticancer therapy, biomedical imaging and other therapies for different diseases, over the past five years. In addition, the remaining challenges and future opportunities have also been evaluated. It is hoped that this review can provide a foundation for broadening the application of ZIF-90 in the clinical treatment, prevention and diagnosis of diseases. A schematic illustration of ZIF-90 nanocomposites applied to anticancer therapy, biomedical imaging and other fields for the treatment of different diseases.