Liu Jian-min, Zhao Hong-yan, Ning Guang, Chen Ying, Zhang Lian-zhen, Sun Li-hao, Zhao Yong-ju, Xu Man-yin, Chen Jia-lun
Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-tong University Medical School, 197 Shanghai Rui-jin Er Road, Shanghai 200025, China.
J Bone Miner Metab. 2008;26(2):159-64. doi: 10.1007/s00774-007-0799-z. Epub 2008 Feb 27.
To find out which of the following parameters-serum levels of insulin-like growth factor 1 (IGF-1), osteoprotegerin (OPG), leptin, osteocalcin (OC), and urinary excretion of N-terminal telopeptide of type I collagen (NTx), can be used as an early marker for osteopenia/osteoporosis in women diagnosed by dual-energy X-ray absorptiometry (DXA), 282 premenopausal and 222 postmenopausal women aged 20-75 years were investigated by the measurement of bone mineral densities (BMDs) at lumbar spine (LS) and femoral neck (FN) by DXA, together with serum concentrations of IGF-1, OPG, leptin, OC, and urinary NTx. The characteristics of the earliest marker(s) were tested with the receiver operating characteristic (ROC) analysis. The area under the curve (AUC), sensitivity, and specificity parameters were determined. It was revealed that serum levels of IGF-1 and leptin changed the earliest, with both markers significantly decreasing (P < 0.0001) or increasing (P = 0.020), respectively, at age 30. However, in ROC analysis, IGF-1 was the only early parameter that had the capacity to differentiate the low bone mass/osteoporosis women from the normal ones (P < 0.0001). If the serum level of IGF-1 at 1.5 SD below its peak was adopted as a cutoff point, it could identify women with low bone mass/osteoporosis with a sensitivity of 73% and specificity of 67%. In the premenopausal women subgroup analysis, the low bone mass women (30/282, 10.6%) were older (38.2 +/- 1.7 vs. 34.5 +/- 0.5 years; P = 0.026), with lower serum levels of IGF-1 (215.1 +/- 22.4 vs. 278.8 +/- 9.4 ng/ml; P = 0.02) and less lean mass (33.1 +/- 0.6 vs. 34.8 +/- 0.2 kg; P = 0.010) than the normal ones. After controlling for age, the serum level of IGF-1 had a weak, but still significant, positive correlation with lean mass (r = 0.17, P < 0.001). In conclusion, measurement of serum IGF-1 in young women may help in the early identification of those at risk for developing low bone mass and osteoporosis.
为了确定以下哪些参数——血清胰岛素样生长因子1（IGF-1）、骨保护素（OPG）、瘦素、骨钙素（OC）以及I型胶原N端肽的尿排泄量（NTx），可作为通过双能X线吸收法（DXA）诊断为骨质减少/骨质疏松的女性的早期标志物，对282名年龄在20 - 75岁的绝经前女性和222名绝经后女性进行了研究，通过DXA测量腰椎（LS）和股骨颈（FN）的骨密度（BMD），同时检测血清中IGF-1、OPG、瘦素、OC的浓度以及尿NTx。通过受试者工作特征（ROC）分析来测试最早标志物的特征。确定曲线下面积（AUC）、敏感性和特异性参数。结果显示，IGF-1和瘦素的血清水平变化最早，在30岁时，这两种标志物分别显著降低（P < 0.0001）或升高（P = 0.020）。然而，在ROC分析中，IGF-1是唯一能够区分低骨量/骨质疏松女性与正常女性的早期参数（P < 0.0001）。如果将IGF-1血清水平低于其峰值1.5个标准差作为截断点，它能够识别低骨量/骨质疏松女性，敏感性为73%，特异性为67%。在绝经前女性亚组分析中，低骨量女性（30/282，10.6%）年龄较大（38.2±1.7岁 vs. 34.5±0.5岁；P = 0.026），血清IGF-1水平较低（215.1±22.4 ng/ml vs. 278.8±9.4 ng/ml；P = 0.02），瘦体重较少（33.1±0.6 kg vs. 34.8±0.2 kg；P = 0.010）。在控制年龄后，血清IGF-1水平与瘦体重呈弱但仍显著的正相关（r = 0.17，P < 0.001）。总之，测量年轻女性血清IGF-1水平可能有助于早期识别那些有发生低骨量和骨质疏松风险的女性。
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