The correlation between non-traumatic avascular necrosis of femoral head and insulin-like growth factor-1 and bone metabolism markers

Abstract

Objectives: To explore the correlation and significance of serum insulin-like growth factor-1 (IGF-1) and bone metabolism markers in patients with non-traumatic avascular necrosis of femoral head (N-ANFH). Methods: A prospective study was conducted on the patients with control and N-ANFH cohorts admitted from the orthopedic department of The Sixth Affiliated Hospital of Guangzhou Medical University from July 2020 to February 2023. The control (n=25) and N-ANFH cohorts (n=30) were randomly selected using block randomization method. The gender, age, body mass index (BMI), IGF-1, bone metabolism markers, including type I collagen hydroxyl terminal peptide β special sequence (β-CTX), N-terminal mid-fragment of osteocalcin (N-MID), total aminoterminal propeptide of type I procollagen (T-PINP), serum 25-hydroxyvitamin (D25(OH)D), parathormone and bone density, were compared between the two cohorts. Single and multiple factor logistic regression analysis were applied to study the correlation between dependent variable and N-ANFH. The expression pattern of IGF-1 in bone tissue from control and N-ANFH cohorts was detected by immunofluorescence (IF). Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DXA) scanning. Pearson correlation analysis was used to analyze the relationship between IGF-1 and BMD, the value of IGF-1 in the diagnosis N-ANFH was evaluated by receiver operating characteristic curve (ROC) analysis. Results: The bone metabolism markers of the control cohort were significantly higher than those of the N-ANFH cohort (p< 0.05), and IF revealed that the expression level of IGF-1 in the control cohort was significantly higher than that of the N-ANFH cohort. The expression level of IGF-1 was positively correlated with hip BMD (r= 0.7569, p= 0.0001). The area under ROC curve (AUC) in the diagnosis of N-ANFH was 0.7373, p= 0.0026, with a cutoff value of 139.6, corresponding sensitivity of 80%, and a specificity of 64%. Conclusion: The bone metabolism level of N-ANFH is significantly reduced, and IGF-1 is not only closely related to the level of osteoporosis, but also one of vital biomarkers for diagnosing N-ANFH, suggesting that decreased bone metabolism level and osteoporosis may be the main causes of N-ANFH.