Insulin-like growth factors I and II: aging and bone density in women

Relation between insulin-like growth factor-I concentrations, osteoarthritis, bone density, and fractures in the general population: the Chingford study

OBJECTIVE

To assess the association between serum insulin-like growth factor-I (IGF-1) concentrations and osteoarthritis, and bone mineral density, and fractures in a large group of middle aged women from the general population.

METHODS

761 women aged 44-64 years from the Chingford study had serum IGF-I concentrations measured; hand, hip, spine, and anteroposterior weight bearing knee radiographs taken; and dual energy x ray absorptiometry (DEXA) scans of the hip and spine. X rays were scored using the Kellgren and Lawrence system. In addition knee x rays were scored using a standard atlas for individual features of osteophytes and joint space narrowing (both graded 0-3). IGF-I concentrations were adjusted for the effects of age.

RESULTS

In the osteoarthritis analysis results were compared to a constant group of 155 subjects with no evidence of osteoarthritis at any site. There was no significant difference in serum IGF-I between these subjects and 606 subjects with osteoarthritis at any site. When individual sites were analysed, serum IGF-I was higher in those cases with more severe bilateral knee osteoarthritis and in those with distal interphalangeal (DIP) joint disease. There was no significant association between serum IGF-I and other forms of osteoarthritis or milder forms of knee osteoarthritis. There was no correlation between IGF-I concentrations and bone mineral density at the spine or hip, nor any difference between IGF-I concentrations in subjects with and without a history of non-traumatic fracture [22.8 (SD 6.6) v 23.1 (SD 6.6) nmol litre-1, P = 0.6]

CONCLUSIONS

There is a modest association between IGF-I concentrations and the development of DIP osteoarthritis and more severe or bilateral knee joint osteoarthritis in women from the normal population, but no association with other forms of osteoarthritis, bone density, or fractures.

Insulin-like growth factor I as a predictor of cortical bone mass in a long-term study of ovariectomized and estrogen-treated rats

The relationship between serum insulin-like growth factor I (IGF-I) and cortical bone mass, formation and resorption and length of bone in a long-term experiment on intact, ovariectomized and estrogen-treated/substituted rats was studied by using multiple linear regression analysis. The study comprised intact rats killed at 2, 6, 9, 12, 15, and 24 months of age, rats ovariectomized 6 months old and killed at 9, 12, 15, and 24 months of age, and intact and ovariectomized rats treated with a low dose of estrogen for 8 months before they were killed at 24 months of age. Serum IGF-I, bone length and total, subperiosteal and subendocortical bone mass in mid-diaphyseal cross sections of the femur were determined. Changes in the latter two variables, respectively, represent the net result of subperiosteal bone formation and subendocortical bone resorption. Multiple linear regression analysis showed that IGF-I was a positive determinant of cortical bone mass and subperiosteal bone formation. In aged rats, IGF-I was also a positive determinant of bone length, whereas IGF-I was not found to be a determinant of subendocortical bone resorption. The analyses showed that long-term treatment of aged rats with a low dose of estrogen had a dual effect on cortical bone by inhibiting subperiosteal formation and subendocortical resorption. The results revealed a relationship between endogenous circulating IGF-I and local anabolic actions of the growth factor in bones. Thus, IGF-I may be a valuable serum marker of cortical bone formation and length of long bones when considering estrogen-depleted and estrogen-treated rats.

Relationship between baseline insulin-like growth factor-I (IGF-I) and femoral bone density in women aged over 70 years: potential implications for the prevention of age-related bone loss

OBJECTIVE

To test the hypothesis that the decline in femoral bone mass associated with healthy aging is partially accounted for by deficiency of the growth hormone-insulin-like growth factor-I (IGF-I) axis.

DESIGN

Cross-sectional study.

STUDY PARTICIPANTS

A sample of 245 community-dwelling healthy women aged 70 and older. Exclusion criteria were diseases or medications known to affect the musculoskeletal system or the somatotrophic axis.

MEASUREMENTS

Serum levels of IGF-I, calcitriol, and osteocalcin were determined by radioimmunoassay; serum calcidiol was measured by competitive binding assay, and serum parathyroid hormone (PTH) was assessed immunochemically. Urinary pyridinium crosslinks were measured by fluorescent detection after high-pressure liquid chromatography. Isometric and isokinetic quadriceps strength was evaluated using an isokinetic dynamometer. Bone density (BMD) was assessed by dual-energy X-ray absorptiometry at the proximal femur. Multiple regression was used to adjust for potential confounders.

RESULTS

At the proximal femur, BMD declined by 0.59-0.84% per year. In addition to body mass index and muscle strength, serum IGF-I was found to be an independent predictor of BMD at all femoral sites.

CONCLUSION

The data support the hypothesis that circulating IGF-I not only reflects the integrated growth hormone secretion but also has a direct role in the endocrine regulation of bone remodeling. The present findings support the need for further studies to assess the potential of IGF-I in attenuating age-related femoral bone loss.

Current and potential future drug treatments for osteoporosis

There has been a major interest in the drug treatment of osteoporosis and an increase in the number of drugs available in most countries. The ideal drug (one which increases or restores bone density and trabecular connectivity) is still not available. However, in patients with relatively preserved trabecular connectivity and moderately reduced bone density, several agents have shown substantial clinical benefit. Oestrogens are still the mainstay of drug treatment, but the risks of breast cancer versus the cardiovascular and skeletal benefits with long term use have to be assessed in the individual. Newer tissue specific oestrogens show some promise in this respect. The bisphosphonates and possibly fluoride are likely to be the major alternatives to oestrogens in the medium term. The newer bisphosphonates, alendronate and in the future risedronate, are likely to supersede etidronate. Calcitriol probably has a limited role, confined to those patients in whom HRT or bisphosphonates are not appropriate. Calcium supplementation, or an increase in dietary intake if deficient, irrespective of which agent is used, is also of benefit. In older patients there is considerable support for using a combination of calcium and vitamin D. Whether combination treatment, for example oestrogens, bisphosphonates, and calcium together, will result in greater efficacy remains to be conclusively shown, but may be an attractive option in younger patients with higher bone turnover. Apart from fluoride, bone formation stimulators are unlikely to have a major role until the next century, although it may be possible to use growth factors as part of an ADFR regimen (A = activate remodelling, D = depress resorption, F = free formation, and R = repeat). This is still an important theoretical approach and needs further work with newer agents to see if increased efficacy can be found. In addition sequential treatment may be necessary in view of the limited time periods over which particular agents, such as intermittent fluoride (four years), have been examined, and this will have to be individually tailored. Other approaches include trying to increase peak bone mineral density, although influencing the young to prevent a disease that may not manifest itself for half a century is daunting.

Effects of progesterone on serum levels of IGF-1 and on femur IGF-1 mRNA in ovariectomized rats

Local and systemic insulin-like growth factors (IGFs) may be involved in the regulation of bone formation by sex hormones. The present studies describe the in vivo effects of estradiol, progesterone, or both on IGF-1 mRNA abundance in bone, serum IGF-1 levels, and bone formation. Rats were sham-operated (SHAM) or ovariectomized (OVX) at 12 weeks of age and used a week later in three experiments. First, OVX rats were treated with vehicle, estradiol, and/or medroxyprogesterone (MPA) for 3 weeks, and bone formation was assessed in the tibial metaphysis. Second, OVX rats were treated in the same manner and serum IGF-1 levels measured. Third, OVX rats were treated with an injection of vehicle, estradiol, and/or progesterone, and 24 h later, levels of IGF-1 mRNA in the femur were analyzed. The mineralized surface, mineral opposition rate, and bone formation rate (BFR) were higher in OVX than in SHAM rats. The BFR was decreased in estrogen-treated but increased in MPA-treated rats compared with vehicle-treated OVX rats. Circulating levels of IGF-1 were higher in OVX than in SHAM rats but were not affected by sex hormones in a 3-week experiment, whereas these levels were not different among groups in a 24-h experiment. Northern analysis detected 7.5 and 0.8 kb IGF-1 mRNA transcripts. The abundance of IGF-1 mRNA was higher in OVX than in SHAM rats. IGF-1 transcripts 7.5 and 0.8 kb were decreased by 72 and 29%, respectively, in estrogen-treated and increased by 44 and 43%, respectively, in progesterone-treated rats compared with vehicle-treated OVX rats. We conclude that in the short term, estrogen lowers and progesterone raises bone IGF-1 mRNA and these changes are followed by coordinated changes in bone formation rate.

Effects of hormonal replacement therapy on plasma sex hormone-binding globulin, androgen and insulin-like growth factor-1 levels in postmenopausal women

Plasma sex hormone-binding globulin (SHBG) levels are important in the regulation of plasma free and albumin-bound androgens and estrogens. In postmenopausal women associated to the decrease of estrogen production, a decrease of plasma SHBG levels occurs. Hormone replacement therapy (HRT) in postmenopausal women modulates plasma SHBG levels, in relationship with the different regimens and routes of administration. The present study aimed to compare the effect of different HRT on plasma SHBG levels in relationship with the changes of plasma androgen [dehydroepiandrosterone sulphate (DHEAS), testosterone (T), androstenedione (A)] and insulin-like growth factor-1 (IGF-1) levels. In a retrospective study 443 postmenopausal women were studied and divided into 2 groups. The group 1 (n = 170) was subdivided in 4 groups of women as follows: A) treated with transdermal 17-beta estradiol + medroxyprogesterone acetate, B) treated with oral conjugated estrogens, C) treated with sequential HRT (estradiol valerate (EV) + norgestrel), and D) treated with a combined HRT (micronized estradiol (E2) + noretisterone acetate). Women of group 2 (n = 273) did not receive HRT and served as controls. All groups of women treated with different HRT showed plasma estradiol levels significantly higher than controls (p < 0.01), showing the highest values in women treated with oral HRT. Plasma SHBG levels were not significantly different between patients treated with transdermal 17-beta estradiol + medroxyprogesterone acetate and controls. On the other hand, all the groups of patients treated with oral conjugated estrogen with or without progestagens showed plasma SHBG levels significantly higher than controls (p < 0.01). Plasma SHBG levels were higher in the group treated with estrogen alone than in groups of women treated with sequential or combined HRT. Plasma DHEAS, T and A levels in patients treated with different HRT regimens were in the same range of levels as control women. Plasma IGF-1 levels were not significantly affected by the various HRT regimens and remained in the same range as controls. In conclusion, plasma SHBG levels increase following oral HRT while are not affected by transdermal HRT. Plasma IGF-1 and androgen levels are not influenced from oral or transdermal HRT.

Altered growth hormone (GH) secretion in women gaining weight during hormone replacement therapy (HRT)

OBJECTIVES

The relationship between GH response to GHRH-stimulation and changes in body weight in pre- and postmenopausal women before as well as after 4 and 20-22 weeks of oral HRT was tested.

METHODS

18 postmenopausal women (FSH > 30 mU/ml) were compared to 18 premenopausal women suffering from post-pill amenorrhoea (FSH < 10 mU/ml). Both patient-groups reported an anamnestic increase in body weight during former use of sex hormones. In addition 18 postmenopausal women without anamnestic weight change were studied.

RESULTS

A significant reduction in GH response to GHRH stimulation was observed during the first month of HRT in both groups gaining weight. However, the body mass index of the patients reverted to pretherapeutic levels after 5 months of HRT. In all patients, a small but statistically significant increase in IGF-1 levels was registered during HRT. These changes in GH stimulation testing and IGF-1 levels were accompanied by distinct changes in body weight. No alterations in GHRH response were observed in those patients whose body weight did not increase.

CONCLUSIONS

Our results confirm that in predisposed women, HRT is associated with increments in body weight as well as with changes in the GH-IGF-1 axis.

Hepatic overexpression of insulin-like growth factor-II in adulthood increases basal and insulin-stimulated glucose disposal in conscious mice

The physiological role of circulating insulin-like growth factor-II (IGF-II) in adult humans is poorly understood. We recently generated an IGF-II transgenic murine model of persistent IGF-II production (plasma IGF-II approximately 30-fold increased above normal) through over-expression of the transgene driven by the major urinary protein promoter (Rinderknecht, E., and Humbel, R. E. (1978) J. Biol. Chem. 269, 13779-13784). To determine whether in vivo insulin action is improved in these transgenic mice, we performed euglycemic insulin (18 milliunits/kg.min) clamp studies in conscious IGF-II transgenic and in age- and weight-matched control mice. Plasma glucose and insulin concentrations were significantly lower in the IGF-II transgenic compared with both control grouoff Despite decreased plasma glucose concentration, basal hepatic glucose production (HGP) and glucose clearance were increased. During the insulin clamp studies in IGF-II transgenic mice compared with control mice (a) the rates of glucose infusion and glucose uptake were increased by approximately by 65 and approximately 55%, respectively; (b) glycolysis was increased by approximately 12% while glycogen synthesis was approximately 2-fold higher; (c) while the suppression of plasma free fatty acid was similar, the increment in plasma lactate concentration was significantly higher; (d) although HGP was similarly inhibited by insulin, phosphoenolpyruvate gluconeogenesis was enhanced and accounted for a larger portion of HGP (64% versus approximately 40% in control mice). Our data suggest that the persistence of circulating IGF-II in adult mice to levels commonly observed in adult humans (50-70 nM) causes a marked improvement in peripheral (skeletal muscle) insulin action, which is not due to changes in body composition. These results suggest that circulating IGF-II may exert a regulatory role on insulin sensitivity and body composition in humans.

The effects of recombinant human insulin-like growth factor (rhIGF)-1 and rhIGF-1/IGF binding protein-3 administration on rat osteopenia induced by ovariectomy with concomitant bilateral sciatic neurectomy

We compared the effect of administration of recombinant human insulin-like growth factor-1 (rhIGF-1) alone or the rhIGF-1/IGF binding protein-3 (IGFBP-3) complex on osteopenia in rats. Female Sprague-Dawley rats (8 months old) underwent combined ovariectomy and bilateral sciatic neurectomy (OVX-NX) or sham operation only. After 2 months, the OVX-NX animals were injected subcutaneously with rhIGF-1 alone or with rhIGF-1A IGFBP-3 equimolar complex for 4 weeks. The IGF-1 contents and dose were 0.3 mg/kg of body weight (BW) three times/week, 3 mg/kg of BW once/week, or 3 mg/kg of BW three times /week. At the end of the experiment, the 4th and 5th lumbar vertebrae (L4, L5) and the proximal tibiae were removed after tetracycline labeling, and histomorphometrical analyses were performed on undecalcified sections using Villanueva's staining. The cancellous bone volume at L5 significantly increased by thickening of the trabecular width in rats treated with the complex. However, the increase in the values at the proximal tibia was not significant. The bone formation rates (BFR/BS) in the lumbar vertebrae of rats treated with the complex three times a week at doses of 0.3 mg/kg of BW and 3 mg/kg of BW were both significantly increased but the parameter increase was less marked with the dose of 3 mg/kg of BW once/week. The BFR/BS did not increase significantly in animals treated with IGF-1 alone. These findings clearly demonstrated that the effect of systemically administered rhIGF-1 on bone formation was markedly potentiated when combined with IGFBP-3 in estrogen deficiency combined with reduced activity. The action of IGF-1 was less potent on the bone in paralyzed limbs. The action of rhIGF-1/IGFBP-3 on trabecular bone appeared to depend not only on the dose but also on the frequency of administration and the parts of the skeleton in rats.

Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures

It is uncertain whether or how rapidly elderly women continue to lose bone with advancing age. To determine rates of change in bone mass at the hip and at the calcaneus in elderly women and to compare these rates of change among estrogen users and nonusers, we prospectively measured rates of change in bone mineral density (BMD) at the total hip and its four subregions (mean +/- SD, 3.55 +/- 0.29 years between examinations) and at the calcaneus (mean +/- SD, 5.69 +/- 0.33 years between examinations) in 5689 community-dwelling white women aged 65 years or older at the baseline examination. The rate of decline in total hip BMD steadily increased from 2.5 mg/cm 2/year (95% confidence interval 2.0 to 2.9) in women 67-69 years old to 10.4 mg/cm 2/year in those aged 85 or older (95% confidence interval 8.4 to 12.4). The rate of bone loss also increased with aging at all subregions of the hip and at the calcaneus. The average loss of bone from the total hip is sufficient to increase the risk of hip fracture by 21% per 5 years in women aged 80 years or older. Compared with nonusers, current estrogen users had a 33% lower age-adjusted mean rate of loss at the total hip (2.9 vs 4.3 mg/cm 2/year, p < or = 0.0001) and a 35% lower age-adjusted mean rate of loss at the calcaneus (3.9 vs 6.0 mg/cm 2/year, p < or = 0.0001). The rate of bone loss in the hip and calcaneus steadily increases with advancing age in older women. Estrogen therapy may significantly decrease this loss. Efforts to understand and prevent bone loss should include elderly women.

An age-related decrease in the concentration of insulin-like growth factor binding protein-5 in human cortical bone

The skeletal contents of insulin-like growth factor-2 (IGF-II), insulin-like growth factor binding protein-5 (IGFBP-5), and insulin-like growth factor binding protein-3 (IGFBP-3) were determined in duplicate samples of human femoral cortical bone obtained from 64 subjects (44 males and 20 females) between the ages of 20 and 64 years. The results of these quantitative measurements revealed an age-related decrease in the femoral cortical content of IGFBP-5 (r = -0.272, P = 0.031) in the total population. Although the femoral cortical content of IGF-II did not show a similar decrease with age, it could be correlated to the femoral cortical content of IGFBP-5 (r = 0.442, P < 0.001). In contrast, the femoral cortical content of IGFBP-3 did not decrease with age and could not be correlated to the femoral cortical contents of either IGFBP-5 or IGF-II. Comparisons of these results with previous measurements of insulin-like growth factor-1 (IGF-I) and transforming growth factor-beta (TGF-beta), in extracts of the same bones, showed significant cross-correlations between the femoral cortical contents of each of these growth factors and the femoral cortical contents of IGFBP-5 (r = 0.625 for IGF-I versus IGFBP-5, r = 0.554 for TGF-beta versus IGFBP-5, P < 0.001 for each) but not IGFBP-3.(ABSTRACT TRUNCATED AT 250 WORDS)

The insulin-like growth factor system and the coupling of formation to resorption

In the adult skeleton, bone formation is regulated by an event referred to as the coupling of formation to resorption (i.e., formation is linked to resorption), which is thought to be mediated in part by locally produced growth factors. Although human bone cells produce and human bones contain a variety of growth factors, there is sufficient evidence to document an important role for the insulin-like growth factor (IGF) system in mediating this coupling process in bone. Studies on the basic aspects of the IGF system in bone reveal that it is complex and involves a number of components which include the IGF-binding proteins (IGFBPs; mainly IGFBP-3, -4, and -5), specific extracellular IGFBP proteases, and receptors (types 1 and 2). Based on recent experimental evidence from a number of laboratories, we propose the following models of IGF action on the regulation of the coupled increase in bone formation in response to bone resorption: (1) IGF release from bone during bone resorption promotes osteoblasts to initiate cavity refilling; (2) IGF production by osteoclasts creates a population of osteoblasts in proportion to the volume of bone tissue resorbed; and (3) IGF production by stromal cells and osteoblasts predominantly regulates the extent of cavity refill. The amount of growth factor production by osteoblasts and contemporary cells of osteoblast lineage can be further controlled by both systemic and local factors which together determine the eventual level of fill-in of the resorption cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential distribution of insulin-like growth factors and their binding proteins within bone: relationship to bone mineral density

To evaluate the possibility that insulin-like growth factors (IGFs) and their binding proteins (BPs) in bone play a role in regulating cortical bone formation in growing animals, we compared changes in IGF and IGF BP levels with changes in bone mineral density (BMD) at three different regions (proximal, middle, and distal) along the rabbit femoral shaft. BMD measured by dual-energy x-ray absorptiometry decreased progressively from proximal to distal regions of the shaft, from 0.449 +/- 0.005 to 0.354 +/- 0.002 g/cm2 (mean +/- SEM; n = 9), respectively; total protein concentrations also decreased toward the distal region. We extracted the IGFs and their BPs from bone by demineralization in 10% EDTA and 4 M guanidine-HCl (pH 4.5). The IGFs were then separated from their BPs by size exclusion HPLC. The pH of the extraction buffer profoundly influenced the recoveries of the IGFs and, to a lesser extent, the total protein; at least 100% more IGFs were recovered at acid (4.5) pH than at neutral (7.5) or basic (10.5) pH. The levels of IGF-I decreased markedly from proximal to distal regions, from 273 +/- 27 to 100 +/- 38 ng human IGF-I equivalent/g bone (or 103 +/- 10 to 52 +/- 11 ng human IGF-I equivalent/mg protein), respectively. IGF-II was uniformly distributed (385 +/- 17 ng human IGF-II equivalent/g bone; mean of all three regions). Levels of the predominant 28-32 kD IGF BP doublet increased by about 100% from proximal to distal segments, regardless of whether the data were expressed per unit mass or protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth hormone, insulin-like growth factors, and the senescent skeleton: Ponce de Leon's Fountain revisited?

As the population ages, the prevalence of osteoporosis will continue to rise. Yet, the mechanisms leading to age-related bone loss remain poorly defined. Furthermore, extensive longitudinal studies of bone mass, especially in the three decades beyond menopause, have not been completed. Although calciotropic hormones, growth hormone (GH), and insulin-like growth factor-I (IGF-I) change with age, it is not certain if these changes are responsible for age-related bone loss. Nor is it clear if the "senescent" osteoblast is fully responsive to growth factor stimulation. To complicate matters further, both circulatory and skeletal IGF regulatory systems are extremely redundant. Changes in serum IGFs may lead to compensatory alterations in IGF receptor number, IGF binding protein (IGFBP) synthesis, or IGFBP catabolism. What is measured in serum, may, in the end, be either a mirror or a mirage of skeletal IGF action! Clinical trials with "replacement" doses of GH or IGF-I are underway. But, critical evidence does not yet support the concept that a true "sommatopause" alters bone remodeling. Moreover, only scarce data exist that GH augments bone formation or prevents bone loss in the elderly. As clinicians expand the use of recombinant growth factors to elders, ethical and clinical issues surrounding administration of the new "fountain of youth" will be revisited. For basic scientists studying skeletal growth factors and their relationship to senescence, significant questions remain unanswered. New technological advances will provide clues about the basic mechanisms of skeletal aging.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of postmenopausal osteoporosis

More than 25% of postmenopausal women are at risk of osteoporosis. In order to avoid its consequences, it is necessary to find an appropriate prevention and/or treatment. We studied: (1) 15 postmenopausal women treated with percutaneous estradiol (50 micrograms/24 h) plus MPA (10 mg/10 days/month); (2) 15 postmenopausal women treated with synthetic calcitonin nasal spray at the daily dose of 100 IU; (3) 10 postmenopausal women treated with nandrolone decanoate (50 mg every 3 weeks); (4) 10 postmenopausal women treated with ipriflavone (600 mg/day); and (5) 10 postmenopausal women treated with sodium fluoride (20 mg) plus calcium (600 mg). Clinical examination, bone mass measurement (total BMD), hematochemical and urinary parameters of bone metabolism (calcium, urinary hydroxyproline, PTH) and growth factors (as IGF-I and TNF-beta) were evaluated. After 6 months of therapy, a complete prevention of bone resorption was achieved. In agreement with current literature, we observed that the various therapeutic approaches have all some positive effect on BMD, with different results on pain, blood biochemical parameters and growth factors' concentrations.

Growth hormone-dependent insulin-like growth factor binding protein is a major determinant of bone mineral density in healthy men

To establish the major determinants of bone mass, we assessed relationships between bone mineral density (BMD) and height, weight, body mass index (BMI), muscle strength, physical capacity (VO2max), body composition, serum concentrations of insulin-like growth factor I (IGF-I), growth hormone (GH), the GH-dependent IGF binding protein (IGFBP-3), testosterone, sex hormone binding globulin (SHBG), osteocalcin, and parathyroid hormone (PTH) in 38 healthy men between 25 and 59 years of age. Values of BMD at all sites (total body, lumbar spine, and hip) were strongly correlated with IGFBP-3 (r = 0.51-0.64, p < 0.001 at all sites), and total-body BMD was also significantly correlated with IGF-I (r = 0.43, p = 0.01). BMD measurements of the total body and of the different sites of the hip were negatively correlated with age and positively with weight, BMI, muscle strength, VO2max, and fat-free weight. IGF-I and IGFBP-3 were both positively related to muscle strength and VO2max. In a stepwise forward multiple-regression analysis, the best model was obtained for the femoral neck, where IGFBP-3, GH, PTH, age, IGF-I, and BMI explained 77% of the variation in BMD. The partial regression coefficients of IGFBP-3, PTH, and BMI were all positive, whereas age, GH, and IGF-I were negatively correlated with BMD. In summary, IGFBP-3 correlated better with BMD than any other study parameter. The findings indicate that GH is of importance for bone mass and suggest that IGFBP-3 not only reflects the integrated GH secretion but also has a direct role in the endocrine regulation of bone metabolism.

Effects of ovariectomy and estrogen on the serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3

To determine the effects of ovariectomy and 17 beta-estradiol (E2) on serum IGF-I and its binding proteins, female Sprague-Dawley rats, aged 95 days, were divided into four groups. Group 1 was sham-operated; groups 2, 3, and 4 were ovariectomized. Groups 3 and 4 received daily injections of 200 ng (low dose) and 5000 ng (high dose) E2/kg body wt./day, respectively and the others were given solvent vehicle. Ovariectomy resulted in a significant increase in serum IGF-I (P < 0.001) at 30 and 35 days post-surgery; the increase was prevented in animals that received low-dose E2 while high-dose E2 reduced serum IGF-I levels below those of the sham-operated controls (P < 0.01). Serum IGF-binding proteins (IGFBPs) were determined by IGF-ligand blot analysis, and the resulting autoradiograms quantified by laser densitometry. The intensity of the IGFBP-3 bands changed in parallel with serum IGF-I levels. Ovariectomy increased, low-dose E2 restored, and high-dose E2 reduced serum IGFBP-3 levels compared to the levels for the sham-operated controls. The intensities of binding protein bands smaller than those of IGFBP-3 appeared unchanged by the treatment regimens. A Western immunoblot analysis with IGFBP-3 antiserum confirmed the ligand-blot data. The changes in the levels of IGF-I and its binding proteins were accompanied by ovariectomy-induced increase in osteoblast and osteoclast numbers and loss of cancellous bone that were attenuated by E2 administration. We conclude that there is a possible role for IGF-I in the pathogenesis of the increased bone turnover that occurs early in ovarian hormone deficiency.

Circulating levels of insulin-like growth factor-I and -II, and IGF-binding protein-3 in inflammation and after parathyroid hormone infusion

In order to assess if the anabolic action of PTH is related to changes in circulating levels of insulin-like growth factor-I and -II (IGF-I and -II), and IGF binding protein 3 (IGFBP-3), 24 h of PTH infusion was performed in healthy women and in patients with rheumatoid arthritis (RA), a state where both bone metabolism and PTH secretion is influenced by the inflammatory activity. The patients with RA had lower basal levels of both IGF-I and -II than the healthy controls (P < 0.05). In neither group did the IGFs change after 24 h of PTH administration, while IGFBP-3 was significantly increased in the healthy controls (4600 +/- 1200 to 5750 +/- 2200 micrograms/l, P < 0.05). IGFBP-3 was not affected by PTH infusion in patients with RA when the disease had high activity, but when inflammation had subsided they responded with a similar increase in IGFBP-3 as the control group and basal IGF-I and -II levels were normalised. Since IGFBP-3 can enhance the anabolic action of IGF-I, increased IGFBP-3 levels after PTH infusion may reflect a mechanism by which PTH is anabolic for bone. Inflammation may inhibit bone formation via decreased serum levels of IGFs and blocked IGFBP-3 response to PTH.

Bone cell biology: new approaches and unanswered questions

In an effort to define the major unanswered questions in bone cell biology and suggest new approaches to answering these questions, I have outlined the bone remodeling cycle and briefly described the major local and systemic factors that regulate bone cell function. These factors include calcium-regulating and systemic hormones as well as locally produced prostaglandins, cytokines, and growth factors. To understand the individual roles of this large number of regulators, it will be necessary to develop new approaches to measure their production and activity in bone under physiologic and pathologic conditions. Quantitative methods in molecular and cellular biology have been developed that should make this identification possible.

Effect of oestrogen status on serum levels of growth hormone-binding protein and insulin-like growth factor-I in non-pregnant and pregnant women

OBJECTIVE

Since there appears to be a relationship between circulating oestrogens and growth hormone, we have investigated the effect of the oestrogen status of adult women on serum levels of GHBP and IGF-I.

DESIGN AND PATIENTS

The investigation was performed on serum samples of 14 spontaneously menstruating women, 10 women taking oral contraceptives containing 20-50 micrograms ethinyloestradiol, and 30 pregnant women at different stages of pregnancy.

MEASUREMENTS

Serum levels of GHBP were measured by HPLC gel filtration and IGF-I levels were measured by RIA after acid-ethanol extraction.

RESULTS

In the spontaneously menstruating women the mean +/- SD serum level of GHBP was 34.6 +/- 6.7% and of IGF-I 30 +/- 7 nmol/l. Serum GHBP levels were negatively (r = -0.67; P < 0.01) and IGF-I levels were positively related (r = 0.69; P < 0.01) to serum oestradiol concentrations. In the women taking oral contraceptives serum levels of GHBP were 47.0 +/- 7.4%. This was significantly (P < 0.001) higher than in spontaneously menstruating women. In contrast, IGF-I levels were not different from those obtained in spontaneously menstruating women. In the pregnant women, the mean +/- SD serum level of GHBP was not different from that observed in non-pregnant spontaneously menstruating women. Polynomial regression analysis, however, showed a significant (P = 0.01) second-order relationship between the duration of pregnancy and serum GHBP levels, with increasing levels during the first half of pregnancy and decreasing levels thereafter. Serum concentrations of IGF-I increased during the second half of pregnancy and were significantly (P < 0.005) elevated in the third trimester.

CONCLUSIONS

In non-pregnant women the endogenous oestrogen status seems to modulate negatively GHBP levels and positively IGF-I levels, whereas oral oestrogen administration, in contrast, increases serum levels of GHBP without modification of IGF-I levels. During pregnancy serum GHBP levels increase slightly during the first half of pregnancy and decrease thereafter, whereas IGF-I concentrations increase during the second part of pregnancy. The oestrogen status of women has a complex effect on serum concentrations of GHBP and IGF-I and has therefore to be taken into account when evaluating serum levels of GHBP and IGF-I.

Low circulating levels of insulin-like growth factors and testosterone in chronically institutionalized elderly men

OBJECTIVE

To determine the prevalences of and the associations between hyposomatomedinemia and hypogonadism in healthy young men, healthy old men, and chronically institutionalized old men.

DESIGN

Survey with serial blood tests.

SETTING

Veterans Affairs nursing home and young and old men living in the community.

SUBJECTS

Three groups were studied: healthy young men (20-29 years old, n = 32), healthy old men (59-98 years old, n = 30), and chronically institutionalized old men (59-95 years old, n = 112).

MEASUREMENTS

Plasma insulin-like growth factor-I (IGF-I), total testosterone (TT), free testosterone (FT), and plasma insulin-like growth factor-II (IGF-II) were measured. In subjects with low testosterone level, serum luteinizing hormone (LH) was also determined. In a subset of chronically institutionalized old men with low IGF-I, the serum growth hormone (GH) level was analyzed during the first 4 hours of sleep.

RESULTS

A low IGF-I level (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 85% of the healthy old men when compared with healthy young men (P < 0.001), in 90% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 26% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). In chronically institutionalized old men with low IGF-I compared with healthy young men, nocturnal peaks of serum GH were < 2 ng/mL in most cases. Low TT (defined as a value below the lower 2.5 percentile of the comparison group) occurred in 86% of the healthy old men when compared with healthy young men (P < 0.001), in 88% of the chronically institutionalized old men when compared with healthy young men (P < 0.001), and in 28% of the chronically institutionalized old men when compared with healthy old men (P < 0.001). The results of FT were similar. In 80% of the institutionalized old men with low TT and FT, the serum LH level was low (< 20 mU/mL). In 53% of the institutionalized old men, the IGF-II level was below the lower 2.5 percentile of the healthy old men (P < 0.001). In both healthy and institutionalized old men, IGF-I and IGF-II levels were significantly correlated to each other (r = 0.6), but neither was significantly correlated to TT or FT. In the institutionalized old men, IGF-I was inversely correlated with age and with a diagnosis of dementia; TT and FT were inversely correlated with age and with the degree of dependency in ADL's.

CONCLUSIONS

Compared with healthy young men, most healthy old men have low serum IGF-I, TT, and FT levels. The geriatric hyposomatomedinemia and hypogonadism are more severe in institutionalized old men. In the latter group, both endocrine deficiencies are usually of central origin, but their occurrences are not significantly associated. Healthy old men usually have a low level of IGF-I compared with healthy young men, but a similar level of IGF-II; institutionalized old men are usually low in both values.

Effect of estrogen deficiency on IGF-I plasma levels: relationship with bone mineral density in perimenopausal women

Bone tissue is a source of growth factors; among them, insulinlike growth factor I (IGF-I) is probably an important local regulator of bone formation. This study has been carried out in order to assess the effects of natural menopause on plasma concentrations of IGF-I in the first 6 years after the cessation of gonadal function independent of age. We also examined the relationship between plasma IGF-I levels and bone mineral density (BMD) measured at the lumbar spine (LS), at the ultradistal radius (UDR), and at the junction of the distal and middle thirds of the radius (MR). Sixty-seven healthy nonobese women, aged 45-55, were studied (premenopausal n = 21; postmenopausal n = 46, from 1 to 6 years since menopause). Plasma IGF-I levels were measured by RIA, after acid-ethanol extraction. BMD of the forearm was measured by dual-photon densitometer and BMD of the LS was assessed by quantitative digital radiography. Mean values of IGF-I plasma levels were significantly reduced in postmenopausal women compared to the premenopausal group. Menopausal duration did not influence IGF-I plasma levels in postmenopausal women. We also found a positive correlation between IGF-I levels and BMD measured at MR both in pre- and postmenopausal women, while a correlation with LS and UDR-BMD was found only in fertile subjects. The results show that IGF-I plasma levels decrease immediately after menopause, since significantly lower levels are reached in the first years. The correlations found between plasma IGF-I levels and BMD suggest a possible role of reduced IGF-I in bone loss at particular skeletal sites.

Relationships between insulin-like growth factor-1 levels and growth hormone concentrations during diurnal profiles and following oral glucose in acromegaly

OBJECTIVE

The aim of this study was to refine the biochemical definition of disease activity in acromegaly by comparing serum growth hormone (GH) measurements during a 10-hour day profile with serum GH values during an oral glucose tolerance test.

DESIGN

Using plasma insulin-like growth factor-1 (IGF-1) levels as a measure of disease activity, serum GH data from a day profile and from an oral glucose tolerance test were compared.

PATIENTS

Thirty-five acromegalic patients were studied, 13 of whom had serum GH measured during a day profile and 22 during an oral glucose tolerance test. In addition, basal plasma IGF-1 levels were estimated in all acromegalic patients, and in 24 normal subjects.

MEASUREMENTS

Following acid-ethanol extraction of the plasma samples, IGF-1 levels were measured by radioimmunoassay using a polyclonal antibody. In a day profile, six to eight blood samples for serum GH estimation were taken at hourly intervals during the day; during an oral glucose tolerance test samples for serum GH estimation were taken in the fasting state and every 30 minutes for 2 hours and measured by a two-site IRMA for GH.

RESULTS

Ninety-four per cent of acromegalic patients with raised plasma IGF-1 levels had serum GH concentrations > 10 mU/l whilst 98% of acromegalic patients with plasma IGF-1 levels in the normal range had serum GH concentrations < 6 mU/l. A highly significant positive correlation was found between the mean serum GH concentrations (r = 0.67), the minimum serum GH concentration (r = 0.65) and the area under the GH curve (r = 0.66) estimated during an oral glucose tolerance test and plasma IGF-1 concentrations. The relations between identical indices of serum GH concentration measured during a day profile and plasma IGF-1 levels, although significant, show a less powerful correlation. The relation between serum GH and plasma IGF-1 levels describes a curvilinear model, plasma IGF-1 levels exhibiting a plateau at serum GH concentrations > 40 mU/l but maintaining a linear relationship with serum GH levels < 20 mU/l.

CONCLUSIONS

A highly significant correlation exists between plasma IGF-1 levels and various parameters of serum GH levels in acromegalic patients. Hormonal assessment of disease activity in acromegaly is more accurately reflected by the serum GH concentration during an oral glucose tolerance test rather than by the serum GH level during a day profile. Normalization of plasma IGF-1 levels is rarely achieved unless the mean serum GH level is reduced to < 6 mU/l.

Southwestern internal medicine conference: growth hormone--aging and osteoporosis

Until recently, the use of growth hormone (GH) has been confined to the treatment of GH-deficient children. The advent of GH produced by recombinant DNA technology has increased the availability of GH. The increased availability of GH has made possible studies of the physiology and the possible therapeutic role of this hormone and its mediator insulin-like growth factor. One area where GH may play a therapeutic role is in the treatment of osteoporosis. This review will briefly summarize normal GH physiology and discuss age-related changes in GH and insulin-like growth factor 1 (IGF-1) axis and how they may relate to age-related physiologic changes. Evidence for and against a possible therapeutic role for GH/IGF-1 in the treatment of age-related (senile) osteoporosis will be discussed.

Growth hormone (GH) and adult bone remodeling: the potential use of GH in treatment of osteoporosis

Decreased osteoblastic activity seems to be of major importance in the pathogenesis of postmenopausal and senile osteoporosis and several lines of evidence suggest that GH may become useful in treatment of osteoporosis. GH stimulates osteoblastic proliferation and differentiation in vitro and increases production of Insulin-like Growth Factor-I and II (IGF-I and IGF-II) which both have profound stimulatory effects on osteoblasts and are important local regulators of bone remodeling. GH affects several other osteotropic hormones in vivo and increases bone turnover while the effect on bone mass is less pronounced and depends on the skeletal compartment. The few published clinical studies on the use of GH in treatment of osteoporosis have been inconclusive and well controlled studies of adequate size are greatly needed. Future research should focus on intermittent use of GH in combination with other hormones stimulating IGF production or antiresorptive agents.

Changes in the ratio of non-calcified collagen to calcified collagen in human vertebrae with advancing age

Bone loss associated with aging is associated primarily with a decline in bone formation. To try and further understand the nature of this process we have used a biochemical approach which relies on the fact that osteoid is susceptible to enzymatic degradation whereas calcified collagen is protected by the mineral phase against proteolytic digestion. Our findings show a statistically significant inverse relationship between osteoid and age (r = 0.70 female, r = 0.47 male). A closer relationship was observed when age was related to the ratio of osteoid to bone (r = 0.73 female, r = 0.56 male). In both cases, the observed linear decline begins at an early age and becomes marked with advancing age. Histologic observations illustrate these findings showing decreased osteoid and osteoblasts in the older vertebral specimens compared to the younger ones. Even though the mechanism for osteoid calcification seems to remain unimpaired, the decline of a calcifiable matrix in the presence of normal bone turnover could lead to bone loss.

Suppression of serum insulin-like growth factor-1 levels in breast cancer patients during adjuvant tamoxifen therapy

Serial IGF-1 levels in patients prior to and during adjuvant tamoxifen (TAM) treatment were followed in a retrospective study. Serum IGF-1 levels were determined by radioimmunoassay in 19 patients taking TAM and 19 controls, matched for age, body weight and other treatments. IGF-1 levels at 2 years were significantly lower in TAM patients (P < or = 0.05) compared to control patients. We observed a significant mean drop from pretreatment to treatment IGF-1 levels by 19.9% in the TAM group (P < or = 0.005), but also noted a mean 11.4% decline in the control group (P < or = 0.025). A subgroup analysis suggested that premenopausal were relatively resistant to the IGF-1 lowering effects of TAM as compared to postmenopausal women.

The bone mineral density in acquired growth hormone deficiency correlates with circulating levels of insulin-like growth factor I

Insulin-like growth factor I (IGF-I) is an important anabolic factor for osteoblasts in vitro. Low plasma levels of IGF-I have been observed in young men with osteoporosis. In the present study, we have studied bone mineral density (BMD) and the circulating levels of IGF-I and growth hormone (GH) in adults with acquired GH deficiency. BMD was determined by dual-energy x-ray absorptiometry in 17 men and 12 women (age 27-54 years). Spinal BMD was positively correlated with the plasma levels of IGF-I (r = 0.43, P = 0.019), with the median of GH values obtained by repeated sampling at night (r = 0.43, P = 0.0019), and with the peak of GH values during GHRH provocation test (r = 0.49, P = 0.039). The total BMD was positively related to plasma IGF-I and median of GH values, but not to peak GH by GHRH provocation. In a multiple regression analysis model, IGF-I, peak GH by GHRH provocation test and duration of GH deficiency explained 49% of the variation in spinal BMD. As compared to healthy controls, total, but not spinal, bone mass was lower in men with GH deficiency, but no clinical symptoms of osteoporosis were observed. The positive relationships between BMD and circulating IGF-I and other indices of GH secretion suggest that IGF-I has an endocrine effect on bone mass.

Bone and cartilage responsiveness to sex steroid hormones

Gonadal steroids influence the skeletal growth and metabolism both during the pubertal growth spurt and in adulthood with aging. It is now generally agreed that sex steroid effect on skeletal tissues is due to indirect and direct actions. In this presentation, in vitro effects of sex steroids on cartilage cells are reported by comparison with those observed on bone cells.

Low plasma levels of insulin-like growth factor 1 (IGF-1) in male patients with idiopathic osteoporosis

Experimental studies in vitro indicate that insulin-like growth factor 1 (IGF-1) could be of importance for normal bone growth and remodelling, but the clinical relevance of these observations is unknown. In 12 consecutive young to middle-aged male patients (mean age (+/- SD) 46 +/- 8 years, range 30-57 years) with symptomatic idiopathic osteoporosis, the plasma concentrations of IGF-1 were significantly lower than in healthy subjects (0.51 +/- 0.25 vs. 0.73 +/- 0.23 U ml-1; P less than 0.01). The bone mineral densities in the spine, the femoral neck, and the forearm were significantly different between patients and control subjects. There were positive correlations between the plasma IGF-1 concentrations and the bone densities of the spine and the forearm. Three of the patients received a 5-d course of human recombinant growth hormone (GH). During this short period significant increases in plasma IGF-1 levels and in biochemical indices of bone turnover (serum bone-specific alkaline phosphatase, urinary calcium excretion) were recorded. These observations indicate that circulating IGF-1 could have an important role in maintaining bone mass, and suggest that impairment of IGF-1 production is involved in the pathogenesis of osteoporosis.

Transdermal 17 beta-estradiol combined with oral progestogen increases plasma levels of insulin-like growth factor-I in postmenopausal women

In order to evaluate the effect of postmenopausal estrogen replacement therapy on the plasma levels of the insulin-like growth factor-I (IGF-I) 12 postmenopausal women aged 44 to 59 years were studied. The control group consisted of 15 healthy premenopausal women aged 20-44 years. In the postmenopausal women the plasma levels of IGF-I, gonadotrophins and sex hormones were determined before and after 3 and 6 months cyclic replacement therapy with transdermal 17 beta-estradiol (E2 100 micrograms patches applied twice weekly) combined with oral chlormadinone acetate (2 mg daily for 7 days in each cycle). Basal levels of estradiol (E2), IGF-I, dehydroepiandrosterone sulphate (DHEA-S), testosterone and androstenedione were lower, but gonadotropin levels were higher in postmenopausal than in premenopausal women. In all the women studied age was inversely correlated with IGF-I levels (r = -0.793, p less than 0.001) and with DHEA-S concentrations (r = -0.435, p less than 0.02). In postmenopausal women transdermal estradiol administration restored the circulating E2 levels to the early follicular range and increased the IGF-I levels (from 76.4 +/- 9.2 micrograms/l to 141.8 +/- 20.8 micrograms/l; p less than 0.01). Transdermal estradiol decreased gonadotrophin levels without changes in concentration of DHEA-S, testosterone, androstenedione and SHBG. In postmenopausal women before and during replacement therapy a positive correlation was found between estradiol and IGF-I concentrations (r = -0.439, p less than 0.01). These results suggest that cyclic replacement therapy with transdermal 17 beta-estradiol in combination with chlormadinone acetate given orally increase the plasma levels of IGF-I in postmenopausal women.

Toward a cure for osteoporosis: reversal of excessive bone fragility

While estrogen replacement therapy and calcium supplementation appear to be effective at preventing postmenopausal osteoporosis, therapy for established osteoporosis is far less effective. The reduction of bone fragility should be a goal of a treatment for established osteoporosis. To this end, increases in cortical bone mass by subperiosteal new bone formation may produce the greatest mechanical advantage. Anti-resorptive drugs, such as etidronate, have shown potential for reducing the incidence of osteoporotic fracture in the short term, but their ability to produce a long-term benefit may be limited. An alternative approach might be to develop drug therapies that substantially increase cortical bone strength, namely by stimulating periosteal bone formation. Although sodium fluoride has proved to be problematic, there are several other potential osteoporosis therapies. They include treatment with anabolic hormones (e.g. growth hormone and anabolic steroids) and targeted delivery of growth factors. Also, anti-resorptive and formation-stimulating drugs might be combined in a new form of ADFR (coherence) therapy where the new acronym means: Activate-Depress-Formation stimulation-Repeat.

Homeostatic control of bone structure: an application of feedback theory

The regulation of bone mass and structure in the weight-bearing skeleton is governed to a great extent by the mechanical demands placed upon the bone tissue. The apparent biological goal is the maintenance of a minimum adequate structure, in which the margin of safety between normal mechanical demands and fracture is balanced by the cost of excessive bone mass on mobility. Frost has developed two powerful postulates concerning bone adaptation: (a) there exist threshold levels of mechanical strain, above or below which bone adaptation is turned on, and (b) the set point for normal bone structure can be modulated by hormones. A model was developed, using Frost's postulates and simple feedback theory, that describes the interaction between biochemical influences and mechanical influences on bone structure. The model predicts that biochemical agents that influence bone structure independently of the mechanical feedback system (e.g., calcitonin) are capable of only limited anabolic effects on bone mass because their influences conflict with mechanical influences. However, biochemical agents that influence bone structure by changing the set point of the mechanical feedback system (e.g., estrogen) will provide lasting changes in bone structure. Age-related changes occur within the effector and transduction components of the mechanical feedback system that tend to make it sluggish. These changes may lead to increased bone fragility because the system is no longer capable of maintaining adequate bone structure.

In vivo actions of insulin-like growth factor-I (IGF-I) on bone formation and resorption in rats

The in vivo action of insulin-like growth factor-I on bone metabolism has been studied using a new model. Insulin-like growth factor-I (IGF-I) was continuously infused into the arterial supply of the right hindlimb of ambulatory rats for up to 14 days and the effects on cortical and trabecular bone formation and the number of osteoclasts were determined by histomorphometric techniques. The contralateral limb acted as an internal control. IGF-I infusion significantly increased cortical bone formation (p less than 0.01). Trabecular bone was increased 22% (p = 0.07), but the infusion was only for seven days. These effects of IGF-I were age dependent, being absent in young, rapidly growing animals, but present at least until one year of age. IGF-I appears to be a purely anabolic hormone for bone formation, since it significantly stimulates osteoblasts and decreases the number of osteoclasts. Thus, although IGF-I mediates the growth-promoting effect of growth hormone, it does not mediate growth hormone's action on bone resorption.

[Principles and clinical significance of insulin-like growth factors/somatomedins]

The Insulin-like Growth Factors (IGFs) or Somatomedins are polypeptide growth factors which are similar to insulin in respect to their aminoacid sequence, structure and biologic activities. The IGFs bind to high affinity receptors which are present on many cells and in many tissues. In the circulation the IGFs are bound to transport (binding) proteins (IGF-BPs). In this review the physiologic role, the basic chemistry and the gene expression of this family of growth factors is summarized systematically. The pathophysiology of growth disorders, diabetes mellitus, malnutrition, liver and kidney disease in relation to the IGFs as well as the therapeutic and diagnostic potentials of these peptides are discussed in detail.

The effect of gonadotropin-releasing hormone agonists on growth hormone secretion in adult premenopausal women

Suppression of the pituitary-gonadal axis by the administration of gonadotropin-releasing hormone agonists (GnRH-a) has been used for a variety of endocrinological and gynecological disorders. The suppressive effect of GnRH-a on luteinizing hormone, follicle-stimulating hormone, and sex steroid production is well documented. However, little is known regarding the effect of GnRH-a on other aspects of pituitary function. The purpose of the present study was to determine the effect of GnRH-a treatment on growth hormone-releasing hormone (GH-RH)-stimulated GH release in premenopausal women. Eight control women and seven women, who were receiving a GnRH-a, were recruited. Before and after a bolus infusion of human GH-RH, blood samples were obtained over 3 hours and analyzed for GH by immunoassay. Basal GH and insulin-like growth factor levels were not statistically different between the two groups. However, basal levels of estradiol and the integrated GH response after GH-RH were significantly lower in the GnRH-a treated women. The reduction in GH-RH-stimulated GH release in GnRH-a treated women may be attributed to diminished endogenous estrogen secretion, or to direct pituitary suppression by GnRH-a, or both.

Exercise patterns and trabecular bone density in college women

To assess the effects of physical activity patterns on trabecular bone density in college women, we studied three groups of nonsmoking eumenorrheic women with different (but chronic) exercise regimens. There were nine sedentary (SED) women exercising less than 1 h/week, nine women who performed aerobic (AER) exercise greater than 2.5 h/week, and nine women who supplemented aerobics with muscle-building activities (MB) for more than 1 h/week. Resting energy expenditure, calorie, protein, and calcium intake, total body weight, and body mass index were not statistically different among the three groups. AER and SED women had similar lumbar bone mineral density (BMD). MB women had significantly greater spinal bone density (p less than 0.007 versus SED, AER). IGF-1 (insulin-like growth factor) concentrations were greatest in MB (p less than 0.01), and hours muscle building per week correlated with IGF-1 (r = 0.86, p less than 0.03). For all 27 women (mean age 24.5 years), body mass index was the single best predictor of lumbar BMD (r = 0.42, p less than 0.03); hours in muscle-building exercise per week conferred an additive effect on lumbar BMD. This cross-sectional study of young women suggests chronic muscle-building exercises may augment lumbar bone mass. The additive effect of anaerobic exercise on bone density may be mediated by both local weight-bearing changes and possible systemic factors.

The metabolism and immunology of bone

Many cells and their cytokines produce a significant effect on bone metabolism. Bone matrix synthesis is a function of the osteoblast (Fig 1), influenced directly by numerous local and systemic factors (Tables 1 and 2). Locally synthesized factors such as SGF, BMP, and BDGF may be particularly important in stimulating new bone formation at sites of bone resorption or following bony injury. Of the systemic factors, GH; somatomedin C (IGF-1); high concentrations of insulin, testosterone, PDGF and TGF beta; and low concentrations of PGE2 and IL-1 appear to stimulate bone formation in vitro. These latter factors may be more important in maintaining skeletal growth and bone mass. Bone resorption by osteoclasts (Figs 2 and 3) is also controlled by the osteoblast, as this cell produces a leukotriene-dependent polypeptide that stimulates osteoclastic bone resorption. Osteoblasts cover the periosteal and endosteal bone-surfaces and limit exposure of the underlying bone to osteoclasts. PTH, vitamin D, PGE2, and other systemic factors interact directly with the osteoblast, not the osteoclast. Surface receptor binding of PTH increases intracellular cAMP and calcium and results in release of the factor that stimulates osteoclastic bone resorption. PGE2 induces osteoblasts to activate osteoclasts and is a major controlling factor in bone metabolism; the osteoblast produces PGE2, which can then modify osteoblastic function by positive feedback. Although low concentrations of PGE2 stimulate bone formation, higher concentrations promote osteoblast-mediated bone resorption. Furthermore, many of the systemic factors stimulate bone resorption via a PGE2-associated mechanism. Immune cytokines also appear to exert a profound influence on bone metabolism. INF-gamma inhibits osteoclastic resorption, whereas IL-1, TNF, and LT strongly stimulate bone resorption. However, low concentrations of IL-1 paradoxically result in stimulation of bone formation. These cytokines, particularly in various combinations, may prove extremely important in understanding and treating the bone loss associated with malignancies, osteoporosis, and rheumatoid arthritis.

Insulin-like growth factor 1 and bone turnover in glucocorticoid-treated and control subjects

The role of the growth hormone-somatomedin axis in the genesis of steroid osteoporosis has been studied by measuring circulating insulin-like growth factor 1 (IGF-1) levels in asthmatic subjects either receiving or not receiving therapy with oral glucocorticoids. There was no difference in IGF-1 levels between the two groups (60.6 micrograms/l (95% confidence interval 47.3-77.8) in the control subjects vs 69.1 micrograms/l (49.3-96.9) in the steroid-treated group). IGF-1 declined with age in the control subjects but not in those taking steroids. When IGF-1 levels were correlated with biochemical indices of bone turnover, a significant relationship was found with urine hydroxyproline in the control subjects (r = 0.55, P less than 0.02) but not in those taking steroids. It is concluded that glucocorticoid therapy does not alter mean circulating levels of IGF-1 but that the growth hormone-somatomedin axis may influence bone turnover in normal subjects. Interference by glucocorticoids with the normal regulation of IGF-1 and its influence on bone turnover is suggested.

Evidence for a direct effect of estrogen on bone cells in vitro

Although the beneficial effects of estrogen in the treatment of postmenopausal osteoporosis are well documented, such effects were difficult to demonstrate in in vitro models. However, recent improvements in bone cell culture models (better defined osteoblastic cell populations, omission of Phenol Red from culture media) enabled several investigators to show albeit small, but reproducible, direct effects of estradiol in various osteoblastic cell types. Such findings were supported by the identification of low numbers of high-affinity estrogen receptors in bone cells derived from different mammalian species. The likely physiological relevance of the in vitro results is indicated by the specificity for 17 beta-estradiol, and the requirement for nanomolar concentrations of the hormone, consistent with a Kd of 0.6 nM for estradiol binding to its receptor [56]. In bone in vitro, estradiol may have anticatabolic effects by decreasing parathyroid hormone responsiveness, and anabolic effects by stimulating matrix synthesis and cell proliferation. Insulin-like growth factor-I is likely to be an autocrine/paracrine mediator for the anabolic effects and may, when associated with its binding proteins, effectively act in the bone compartment.

Primary structure of human skeletal growth factor: homology with human insulin-like growth factor-II

Human skeletal growth factor (human SGF) extracted from human bone has been purified to homogeneity by hydroxyapatite chromatography and gel filtration under dissociative conditions followed by FPLC heparin-Sepharose affinity chromatography and reverse phase HPLC. Human SGF was homogeneous except that in each preparation about 30% of SGF molecules lacked the N-terminal alanine. 75% of the human SGF sequence has been determined. The amino acid sequences of the N-terminal 20 amino acids and of several tryptic fragments were identical to the corresponding sequences of human insulin-like growth factor-II (IGF-II) purified from serum. However, since the C-peptide (variable region) of human SGF has not yet been sequenced, we cannot conclude that SGF is identical to IGF-II. Comparison of the amino acid sequence of human SGF with that of IGF-II variants that have been described in the literature revealed that human SGF is not one of the known IGF-II variants. IGF-I was also found in human bone extract but was several-fold less abundant than SGF/IGF-II. The relative abundance of SGF/IGF-II and IGF-I in bone corresponded to the relative rates of production of these two mitogens by human bone cells in vitro. Regarding the physiological significance of IGF-II in bone, previous studies on the biological actions of SGF in vitro suggest that this growth factor can have both paracrine and autocrine functions on cells of the osteoblast line. In addition, we have proposed the concept that SGF is a mediator of the coupling of bone formation to bone resorption, an important bone volume regulatory mechanism. In as much as SGF is very similar (if not identical) to IGF-II, it seems likely that these proposed regulatory functions of SGF in bone are attributable to IGF-II.