Serum Insulin-like Growth Factor-1 and Growth Hormone as Potential Diagnostic Biomarkers for Postmenopausal Osteoporosis Among Chinese Women

Summary

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.

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-....

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 southe....

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 (.......

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.......

Materials

List of materials used in this article

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