Insulin-like growth factor-1 as a potential diagnostic biomarker for non-traumatic avascular necrosis of femoral head: a prospective study

Abstract

Abstract Background The etiopathogenesis of non-traumatic avascular necrosis of femoral head (N-ANFH) is still elusive. Its accurate early diagnosis remains challenging. Aimed to identify potential biomarkers, we evaluated the relationship between serum insulin-like growth factor-1 (IGF-1) and 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), bone metabolism (BM) markers, including IGF-1, 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. Then Univariate and multivariate logistic regression analysis were applied. 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. Furthermore, the line regression and Pearson correlation analysis were used to analyze the relationship between IGF-1 and BMD, the value of these markers in the diagnosis N-ANFH was evaluated by receiver operating characteristic curve (ROC) analysis. Results The BM markers of the N-ANFH cohort were significantly decrease than those of the control 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). Among these BM markers, IGF-1 shown the most significant area under ROC curve (AUC) in the diagnosis of N-ANFH, which was 0.7373, p = 0.0026, with a cutoff value of 139.6, corresponding sensitivity of 80%, and a specificity of 64%. Conclusions The level of BM in N-ANFH is significantly decreased. Among these BM markers, IGF-1 was most closely associated with N-ANFH and may serve as potential adjuvant biomarkers in the early diagnosis of N-ANFH.