This study aimed to assess serum insulin-like growth factor-1(IGF-1) and growth hormone (GH) as complementary biomarkers for postmenopausal osteoporosis screening in Chinese postmenopausal women. This study identified that IGF-1 effectively identifies low bone mass while GH does not, supporting its use as a viable alternative to dual-energy X-ray absorptiometry (DEXA) scans.
Research Article
Serum Insulin-like Growth Factor-1 and Growth Hormone as Potential Diagnostic Biomarkers for Postmenopausal Osteoporosis Among Chinese Women
In This Article
Summary
Abstract
Postmenopausal osteoporosis (PMOP) is a significant concern among females. The gold standard for diagnosis involves dual-energy X-ray absorptiometry (DEXA) scans to measure bone mineral density (BMD). However, DEXA becomes impractical when the scanner is unavailable. This study included 345 postmenopausal women aged 45-70 years. All participants underwent DEXA scans and had IGF-1, and GH levels measured. Based on t-scores, subjects were categorized into three groups: control (n = 99), osteopenia (n = 153), and osteoporosis (n = 93). ANOVA assessed IGF-1 and GH across groups. Statistical analyses explored correlations between IGF-1, GH, and other parameters. The diagnostic utility of IGF-1 and GH was evaluated using receiver operating characteristic (ROC) curves. Significant intergroup differences were observed for IGF-1 and GH. IGF-1 exhibited negative correlations with age, menopause duration, procollagen 1 Intact N-Terminal pro peptide (PⅠNP), and parathyroid hormone (PTH), while positively correlating with body mass index (BMI), estradiol (E2), GH, BMD, and t-scores. GH showed negative correlations with age, menopause duration, BMI, and PTH, and positive correlations with E2, IGF-1, BMD, and t-scores. ROC analysis indicated high accuracy, specificity, and sensitivity of IGF-1 cutoff values in distinguishing the control group from those with bone mineral deficiency. However, these results were not replicated for GH. Serum IGF-1 measurement holds promise for screening postmenopausal patients. Subsequent DEXA scanning should be considered for severity grading of osteoporosis if indicated. In contrast, GH proved inadequate for diagnosing postmenopausal osteoporosis. In conclusion, serum IGF-1 levels offer a promising screening tool for low bone mass conditions in postmenopausal women, particularly in settings without access to DEXA scanners. Severity grading using DEXA could be facilitated with IGF-1 levels under the cutoff point. In contrast, GH lacks diagnostic potential for PMOP. This study advances the identification of novel serum markers for the diagnosis of clinical postmenopausal osteopenia/osteoporosis.
Introduction
Osteoporosis constitutes a major global health burden characterized by compromised skeletal integrity and elevated fracture risk, with postmenopausal women bearing the greatest disease burden1. Postmenopausal osteoporosis (PMOP) accounts for over 40% of osteoporotic fractures worldwide, imposing substantial morbidity and socioeconomic costs2. The accelerated bone loss following estrogen withdrawal leads to disproportionate trabecular thinning and disrupted microarchitecture - pathological hallmarks distinguishing PMOP from age-related bone loss3. Despite established diagnostic criteria using dual-energy X-ray absorptiometry (DEXA), approximately 60% of fragility fractures occur in individuals not meeting osteoporosis thresholds by bone mineral density (BMD) criteria alone, underscoring the imperative to identify complementary biomarkers reflecting bone quality deterioration4.
The estrogen deficiency state fundamentally alters bone remodeling dynamics through multiple pathways. Beyond its direct anti-resorptive effects, estrogen (E2) modulates osteoanabolic signaling via crosstalk with endocrine networks5. Emerging evidence positions the GH/IGF-1 axis as a critical mediator of skeletal actions by E2. Experimental models demonstrate E2 stimulates IGF-1 mRNA expression in osteoprogenitor cells, while anti-IGF-1 antibodies abolish E2-induced calvarial proliferation in dose-dependent fashion6,7. Clinical observations reveal positive correlations between circulating IGF-1 levels and BMD in postmenopausal cohorts8, though current understanding remains fragmented regarding the temporal relationship between GH/IGF-1 alterations and PMOP progression.
While GH and IGF-1 are established regulators of skeletal growth and maturation, their diagnostic utility in PMOP remains underexplored. These pleiotropic hormones influence bone homeostasis through dual mechanisms: IGF-1 directly stimulates osteoblast differentiation and matrix mineralization, while GH enhances bone remodeling via both IGF-1-dependent and independent pathways9,10. Crucially, the GH/IGF-1 axis exhibits sexual dimorphism and menopause-associated dysregulation - serum IGF-1 concentrations decline by 20-30% during menopausal transition independent of age11. Paradoxically, existing diagnostic frameworks neglect this endocrine dimension, relying predominantly on structural BMD measurements rather than functional metabolic indicators. A critical unresolved question is whether and how this menopause-associated decline in the GH/IGF-1 axis contributes specifically to the deterioration of bone microarchitecture, and whether it holds diagnostic value independent of BMD in Chinese postmenopausal women.
This study investigates the clinical validity of serum IGF-1 and GH as complementary biomarkers for PMOP screening in Chinese postmenopausal women. The study hypothesizes that diminished GH/IGF-1 activity correlates with advanced bone deterioration independent of BMD values, potentially enhancing early risk stratification. By analyzing hormonal profiles in conjunction with DEXA parameters and fracture history, this work addresses critical knowledge gaps regarding: 1) the predictive capacity of GH/IGF-1 for microarchitectural deterioration, and 2) ethnic-specific biomarker thresholds in Asian populations where traditional BMD criteria may underestimate fracture risk. Study findings could inform novel diagnostic algorithms integrating endocrine and densitometric parameters to improve precision in the management of PMOP. The novelty of this translational study lies in its systematic evaluation of the GH/IGF-1 axis as a potential diagnostic adjunct in Chinese postmenopausal women. We aim to elucidate its association with bone microarchitectural deterioration and fracture risk, independent of BMD, and to establish ethnicity-specific thresholds for clinical risk stratification.
Protocol
The research adhered to the ethical guidelines outlined in the World Medical Association's Declaration of Helsinki (Code of Ethics) for human experimentation. Ethical clearance (Approval No. Nan Bu Zhan Qu-LL-2020-047) was secured from the ethics committee of the general hospital of the southern theater command of the Chinese People's Liberation Army, and informed consent was obtained from all participating patients and their families.
Research object
This prospective study spanned four years and was conducted at the inpatient department and physical examination department of the general hospital of the southern theater under the purview of the Chinese People's Liberation Army. It focused on a cohort of postmenopausal women aged 45 to 70 years, using a rigorous cross-sectional design. Exclusion criteria encompassed conditions that potentially impact bone metabolism, including: a) immune system disorders such as ankylosing spondylitis, systemic lupus erythematosus, and rheumatoid arthritis; b) bone tuberculosis; c) disorders affecting adrenal function, severe hepatic or renal insufficiency; d) endocrine disturbances including parathyroid dysfunction, thyroid disorders, and diabetes; e) historical habits of smoking and alcohol consumption; and f) recent use (within the preceding 12 months) of medications with potential effects on bone metabolism, such as glucocorticoids, calcium preparations, vitamin D supplements, bisphosphonates, diuretics, anticonvulsants, and fluoride agents.
Following the diagnostic criteria set forth by the world health organization, the study enrolled a total of 345 subjects, segregated into three distinct cohorts based on bone health status: the control group (characterized by normal BMD, t-score ≥-1.0 SD, n = 99), the osteopenia group (-2.5 SD < t-score < -1.0 SD, n = 153), and the osteoporosis group (t-score ≤-2.5 SD or concurrent fragility fracture, n = 93).
Clinical samples
Patients diagnosed with osteoporosis in the clinical diagnosis of the General Hospital of the Southern Theater Command of the Chinese People's Liberation Army from September 2020 to June 2025, who must meet the following standards: patients with osteopenia and osteoporosis in accordance with the WHO diagnostic criteria; Naturally menopausal, naturally menopausal for ≥1 year, and patients with postmenopausal diseases; Age 45 years ≤ age < 70; Voluntary participation in the investigation. Those meeting all the above conditions can be included in the experimental cases. Normal bone mass group: Naturally menopausal, naturally menopausal for ≥1 year, and those with normal physical examination indicators (including bone density and hematological tests).
For clinical patients who meet the above criteria, patients with the following other diseases must be excluded. The exclusion criteria are as follows: Parathyroid dysfunction, thyroid diseases, diabetes, adrenal diseases, and severe liver and kidney dysfunction, history of malignant tumors, immune system diseases such as ankylosing spondylitis, systemic lupus erythematosus, and rheumatoid arthritis, premature ovarian failure syndrome and oophorectomy, spinal tuberculosis, joint tuberculosis, suppurative arthritis, osteolysis, etc. Patients who have taken drugs that affect bone metabolism (within the past 12 months), such as glucocorticoids, calcium drugs, vitamin D, bisphosphonate preparations, diuretics, anticonvulsants, fluoride, etc., can also be excluded. The presence of any one of the above conditions can lead to exclusion.
Data collection
Participant demographics, including age, years since menopause, height, and weight, were documented. The body mass index (BMI) was calculated using the formula
BMI = Weight (kg) / Height (m2).
Serum sample collection
Following an overnight fast, blood samples were obtained from all participants. Subsequently, serum was promptly separated by centrifugation at approximately 850 × g for 5 min, aliquoted, and stored at -80 °C for subsequent analysis.
Sample size calculation
A priori power analysis was performed using G*Power. Based on preliminary data showing mean serum IGF-1 levels of 89.46 ± 18.89, 72.52 ± 16.32, and 60.23 ± 15.63 ng/mL for the normal bone mass, osteopenia, and osteoporosis groups, respectively, the calculated effect size (Cohen's f) was 0.86. With α = 0.05 and power = 0.80 for a one-way ANOVA, a minimum of 9 participants per group (27 total) was required. To ensure robustness for our cross-sectional design-accounting for multivariable adjustment, subgroup analyses, and potential data issues-we targeted a larger sample. The final cohort included 345 postmenopausal women (99 with normal bone mass, 153 with osteopenia, 93 with osteoporosis), well exceeding the calculated requirement.
Clinical data assessment
Bone mineral density measurement
Bone mineral density (BMD) was assessed using a DEXA scan at the lumbar spine (L1-4), left femoral neck, and upper end of the femoral neck. Scans of the femoral neck and upper end were conducted with flexed knees, while the supine position was maintained during lumbar spine (L1-4) scans. Trained professionals from the nuclear medicine department of the general hospital of the Southern Theater Command of the Chinese People's Liberation Army administered all tests. Prior to each measurement, a quality control prosthesis scan was performed, ensuring rigorous standards were met before proceeding with participant scans. The coefficient of variation was recorded at 0.40%. BMD values were expressed in g/cm².
Serum indicator measurement
Serum indicator measurements were conducted at the laboratory department of the general hospital of the Southern Theater Command of the Chinese People's Liberation Army. The panel of assessed indicators primarily comprised GH, IGF-1, 25-hydroxyvitamin D [25(OH)D], β-collagen degradation products (β-CTX), total collagen type I amino-terminal propeptide (PⅠNP), parathyroid hormone (PTH), N-terminal osteocalcin (BGP), calcium (Ca), and estradiol (E2). The operations are carried out strictly in accordance with the kit instructions, and the process uses automated equipment from the laboratory department (GE). Timely recording of the assay outcomes following their analysis was ensured.
The experimental methodologies employed for the respective indicators were as follows: GH quantification was performed through luminol electrochemiluminescence immunoassay; IGF-1 levels were determined using enzyme-linked immunosorbent assay and chemiluminescence techniques. E2 levels were measured using a commercial immunoassay kit. Serum calcium measurements were performed using a colorimetric method on an automated biochemistry analyzer. The analysis of 25(OH)D, β-CTX, PⅠNP, PTH, and BGP was measured using electrochemiluminescence immunoassay (ECLIA) with commercial assay kits.
Instruments and reagents
The key commercial instruments, assay kits, and reagents used in this study are listed comprehensively in the Table of Materials.
Statistical analysis
Data analysis employed the SPSS 20.0 statistical software package and GraphPad Prism7. Results were presented as mean ± SE. Univariate analysis of variance (ANOVA), Pearson's correlation analysis, partial correlation analysis, and ROC analysis were appropriately applied. A significance level of P < 0.05 was adopted.
Results
Baseline characteristics and serum GH/IGF-I levels comparison
Statistical analysis revealed that bone mass changes in patients with osteoporosis were significantly positively correlated with years since menopause, BMI, and serum E2 levels (P < 0.05), and significantly negatively correlated with serum 25(OH)D, PTH, β-CTX, and PINP levels (P < 0.05). Notably, the serum GH and IGF-1 levels in the osteoporosis group were significantly lower than those in the control group and the osteopenia group (P < 0.05), and the GH and IGF-1 levels in the osteopenia group were also significantly lower than those in the normal bone mass group (P < 0.05). Additionally, serum IGF-1 and GH levels were significantly positively correlated with bone mineral density (BMD) and T values of the lumbar spine (L1-L4), left femoral neck, and proximal femur (Table 1, Table 2,and Table 3).
ROC analysis for diagnostic efficacy of serum IGF-1 and GH for osteoporosis
In the ROC analysis assessing serum IGF-1 concentrations for osteoporosis detection, the diagnostic threshold for identifying low bone mass conditions (osteopenia or osteoporosis) was determined at 73.355 ng/mL, with higher values indicating bone mineral deficiency (osteopenia with osteoporosis). This yielded a sensitivity of 83.8% and specificity of 69.5%, with an area under the curve (AUC) of 0.822 (P < 0.001). The critical serum IGF-1 concentration for osteopenia detection was 74.08 ng/mL between the control and osteopenia groups, yielding a sensitivity of 79.8% and specificity of 62.1%, with an AUC of 0.757 (P < 0.001). For osteoporosis detection, the critical serum IGF-1 concentration was established at 69.74 ng/mL between the control and osteoporosis group. This yielded a sensitivity of 91.9%, specificity of 86%, and an AUC of 0.929 (P < 0.001) (Figure 1A-C and Table 4).
In the ROC analysis assessing serum GH concentrations for osteoporosis detection, the serum GH cutoff for diagnosing low bone mass was set at 0.0785 ng/mL, with a higher value in the bone mineral deficiency group. This yielded a sensitivity of 85.9% and specificity of 30.5%, with an AUC of 0.574 (P < 0.05). For diagnosing osteopenia, the serum GH concentration threshold was determined at 0.517 ng/mL between the control and osteopenia group, resulting in a sensitivity of 87.9% and specificity of 28.1%, with an AUC of 0.562 (P > 0.05). Detecting osteoporosis involved a serum GH concentration critical value of 0.0785 ng/mL between the control and osteoporosis group, yielding a sensitivity of 85.9%, specificity of 31.2%, and an AUC of 0.593 (P < 0.05) (Figure 1D-F and Table 5).
DATA AVAILABILITY:
All original data generated in this study have been deposited as supplementary files.
Figure 1: Diagnostic efficacy of serum IGF-1 and GH for osteoporosis assessed by ROC curves. (A-C) ROC curves of serum IGF-1 for discriminating between subjects with normal bone mass and those with (A) bone mineral deficiency (combined osteopenia and osteoporosis), (B) osteopenia, and (C) osteoporosis. Comparing the AUC values across these panels helps assess the discriminatory power of IGF-1 at different stages-from early risk to established disease. (D-F) Corresponding ROC curves of serum GH for the same comparisons: (D) normal vs. bone mineral deficiency, (E) normal vs. osteopenia, and (F) normal vs. osteoporosis. This side-by-side presentation enables direct comparison of the diagnostic value of IGF-1 and GH across the spectrum of bone-loss severity. Abbreviations; IGF-I = insulin growth factor-I; GH = growth hormone; ROC = receiver operating characteristics; AUC = area under the curve. Please click here to view a larger version of this figure.
Table 1: Comparison of baseline characteristics, serum growth hormone, and IGF-I Levels among the three groups. This table shows the comparison of serum growth hormone, and insulin growth factor-I levels across three groups. Compared with the control group, * represents P < 0.05; compared with the osteopenia group, # represents P < 0.05. The specific statistical significance test used was Univariate analysis of variance (ANOVA), t-test. Abbreviations; IGF-I = insulin growth factor-I. Please click here to download this Table.
Table 2: Correlation analysis between IGF-1, GH, and other variables. This table explains the correlation analysis considering other variables, IGF-1, and GH. The specific statistical significance test used Pearson's correlation analysis, t-test. Abbreviations; IGF-I = insulin growth factor-I; GH = growth hormone. Please click here to download this Table.
Table 3: Partial correlation analysis of serum IGF-1 and GH concentrations. This table shows the partial correlation analysis of serum hormone levels with adjustment for age, BMI, and years since menopause. The specific statistical significance test used partial correlation analysis, t-test. Abbreviations; IGF-I = insulin growth factor-I; GH = growth hormone; BMI = body mass index. Please click here to download this Table.
Table 4: ROC curve analysis results. This table shows the ROC curve analysis results for serum IGF-1 in the diagnosis of osteoporosis. The specific statistical significance test used was ROC analysis, a test of the AUC. Abbreviations: ROC = receiver operating characteristic curve; AUC = area under the curve. Please click here to download this Table.
Table 5: Osteoporosis detection. Detecting osteoporosis involves comparing critical growth hormone concentration between the control and osteoporosis groups, yielding sensitivity and specificity, along with AUC analysis. Abbreviations: AUC = area under the curve. Please click here to download this Table.
Discussion
Bone mineral density (BMD) serves as a pivotal determinant of bone strength, complemented by clinical features in osteoporosis diagnosis12. However, BMD's applicability as an epidemiological screening tool is impeded by cost and accessibility concerns4. While bone turnover markers guide therapeutic response assessment, their diagnostic limitations persist13. Addressing the role of IGF-1 and GH in postmenopausal osteoporosis, this study explored their potential as serum markers for diagnosis. Current study established serum IGF-1 and GH cutoff points, differentiating normal bone conditions from low mineral states among postmenopausal women in China, with evaluation of accuracy, specificity, and sensitivity.
In PMOP, serum E2 levels were lower than in the osteopenia group, whereas the osteopenia group showed lower levels than controls. Enhanced bone turnover markers, including serum PTH, PⅠNP, and β-CTX, aligned with high bone turnover characteristic of PMOP14. However, minimal biomarker differences between the control and osteopenia groups suggested insensitivity to alterations in bone metabolism in postmenopausal osteopenia.
Vitamin D's role in enhancing calcium absorption, thus boosting bone density, is evident. Serum 25(OH)D, reflecting vitamin D metabolism, is deemed sufficient above 30 ng/mL (75 nmol/L), insufficient between 20 and 30 ng/mL (50-75 nmol/L), and deficient below 20 ng/mL (50 nmol/L)15. Consistent with the previous study16, this study unveiled vitamin D insufficiency in 60.3% of postmenopausal women, possibly attributed to reduced sunlight exposure, air pollution, and limited outdoor engagement17,18.
IGF-1's pivotal role as a bone growth and remodeling regulator is recognized19. In vivo, IGF-1 affects bone length growth, while in vitro, it promotes mitosis and mineralization in preosteoblasts20,21. The effects of IGF-1 on bone occur through the regulation of paracrine and endocrine signaling pathways10. Endocrine regulation is mainly mediated by serum IGF-1 produced by the liver, while paracrine regulation is mainly mediated by IGF-1 produced by osteoblasts and myeloid cells22. Previous studies have shown that E2 can stimulate the expression of IGF-1 in osteoblasts23. In this study, it was found that positive correlations between serum IGF-1, E2, and BMD, and the t-scores of the lumbar spine, femoral neck, and upper femur, were coupled with inverse correlations with PTH and PⅠNP. These associations endured post-adjustment for age, BMI, and menopausal duration, indicating IGF-1's potential as a mediator of E2's influence on bone metabolism. ROC curve analysis revealed specific cutoff values for serum IGF-1 levels that differentiated deficient bone subjects from the normal population.
E2's pivotal role in the GH/IGF-1 axis for mitigating postmenopausal bone loss is evident. E2 supports GH cell proliferation and sustenance in the adult pituitary gland24. Estrogen replacement therapy augments bone metrics, serum GH, and IGF-1 in ovariectomized osteoporotic rats. E2's direct interaction with estrogen receptors in the hypothalamus stimulates GH secretion through growth hormone-releasing hormone25,26. While GH's positive relationship with bone metrics persisted, its limited diagnostic utility might result from pulsatile secretion influenced by sleep, health, and nutrition. A large, multi-center, cross-sectional study incorporating comprehensive serum GH assessment is essential to elucidate GH's role in postmenopausal bone loss.
This study has several limitations. First, it did not assess IGF-1 gene polymorphisms, which are known to influence both circulating IGF-1 levels and bone metabolism in postmenopausal women27,28; therefore, this study could not determine the extent to which the observed associations between serum IGF-1 and BMD were modulated by underlying genetic variations. Second, in vitro cell experiments and in vivo animal model validations have not been conducted, so the causal mechanisms by which serum IGF-1, GH, and other hormones regulate bone metabolism have not been directly clarified at the functional level. Nevertheless, focus was on the clinical utility of a readily measurable serum biomarker, and the findings demonstrate that serum IGF-1 level, as an integrative phenotype reflecting the net effects of genetics, age, nutrition, and hepatic function, retains strong and independent associations with bone mass.
Future studies that concurrently incorporate IGF-1 genotyping and serial serum measurements in longitudinal cohorts are warranted to disentangle the genetic and non-genetic contributions to IGF-1 related osteoporosis risk. Furthermore, it will be important to establish ovariectomized mouse models and perform osteoblast/osteoclast intervention experiments to systematically evaluate the impact of hormonal changes on the dynamic balance between bone formation and bone resorption, thereby providing reliable experimental evidence for in-depth mechanistic analysis. In conclusion, this study identifies serum IGF-1 as a promising screening tool for low bone mass in postmenopausal women. This conclusion is supported by findings that serum IGF-1 levels were significantly lower in the osteopenia and osteoporosis groups than in the control group and demonstrated clinically useful diagnostic performance, with an area under the ROC curve of 0.822 for distinguishing low bone mass from normal. This suggests its utility in settings without direct access to DEXA scanners. Furthermore, the observed progressive decline in IGF-1 levels across the control, osteopenia, and osteoporosis subgroups provides a rationale for its potential use in severity grading, when combined with the established DEXA T-score cutoffs. In contrast, these results showed that GH levels did not differ significantly among the study groups and failed to show significant diagnostic value in ROC analysis, leading to the conclusion that GH lacks diagnostic potential for postmenopausal osteoporosis. Collectively, these results advance the identification of novel serum markers, specifically highlighting IGF-1, for the clinical assessment of postmenopausal osteopenia and osteoporosis.
Disclosures
Hairong Su, Qing Zhao, Zhengting Wu, Weimin Deng, Junling Wang, and Binxiu Zhao declare that they have no conflict of interest. The authors confirm that the manuscript represents original work, has not been published previously, and is not under consideration for publication elsewhere.
Acknowledgements
We are grateful to the General Hospital of the Southern Theater Command of the Chinese People's Liberation Army for its support of this research. This work was supported by Scientific Research Foundation for Doctors of Maoming People's Hospital (BS2022001); General Program of National Natural Science Foundation of China (11975084); High-level Hospital Construction Research Project of Maoming People's Hospital; National Natural Science Foundation of China (Grant No. 82305287); Major science and technology project of Chinese medicine in Guangzhou (2025QN012).
Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 25(OH)D3 Kit | Roche Diagnostics | 3017970190 | For 25-hydroxyvitamin D [25(OH)D] detection |
| β-CTX Kit | Roche Diagnostics | 3017938190 | For β-collagen degradation products (β-CTX) detection |
| BGP Kit | Roche Diagnostics | 3017912190 | For N-terminal osteocalcin (BGP) detection |
| Centrifuge | Labortechnik (Hermle) | Z 216 MK | Experimental conditions: 4 °C, 18620 g, centrifugation for 20 min |
| Dual-energy X-ray absorptiometry (DEXA) scans | GE Healthcar | Lunar Prodigy | For bone mineral density (BMD) and body composition measurement. |
| E2 Kit | Roche Diagnostics | 3017888190 | For estradiol (E2) detection |
| GH Kit | Roche Diagnostics | 3017954190 | For growth hormone (GH) detection |
| IGF-1 Kit | Roche Diagnostics | 3017962190 | For insulin-like growth factor-1 (IGF-1) detection |
| PINP Kit | Roche Diagnostics | 3017946190 | For total collagen type I amino-terminal propeptide (PINP) detection |
| PTH Kit | Roche Diagnostics | 3017920190 | For parathyroid hormone (PTH) detection |
| Roche Cobas c Series Biochemical Analyzer | Roche Diagnostics | cobas c 702 | Instrument for calcium biochemical detection |
| Roche Cobas e Series Electrochemiluminescence Analyzer | Roche Diagnostics | cobas e 602 | Instrument for immunoassay detection |
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