Growth hormone (GH) and insulin like growth factor-I (IGFI) are key bone trophic hormones, whose rising levels during puberty are critical for pubertal bone accrual. Conditions of GH deficiency and genetic resistance impact cortical and trabecular bone deleteriously with reduced estimates of bone strength. In humans, conditions of undernutrition (as in anorexia nervosa (AN), or subsequent to chronic illnesses) are associated with low IGF-I levels, which correlate with disease severity, and also with lower bone mineral density (BMD), impaired bone structure and lower strength estimates. In adolescents and adults with AN, studies have demonstrated a nutritionally acquired GH resistance with low IGF-I levels despite high concentrations of GH. IGF-I levels go up with increasing body weight, and are associated with rising levels of bone turnover markers. In short-term studies lasting 6–10 days, recombinant human IGF-I (rhIGF-I) administration in physiologic replacement doses normalized IGF-I levels and increased levels of bone formation markers in both adults and adolescents with AN. In a randomized controlled trial in adults with AN in which participants were randomized to one of four arms: (i) rhIGF-I with oral estrogen-progesterone (EP), (ii) rhIGF-I alone, (iii) EP alone, or (iv) neither for 9 months, a significant increase in bone formation markers was noted in the groups that received rhIGF-I, and a significant decrease in bone resorption markers in the groups that received EP. The group that received both rhIGF-I and EP had a significant increase in bone density at the spine and hip compared to the group that received neither. Side effects were minimal, with no documented fingerstick glucose of <50 mg/dl. These data thus suggest a potential role for rhIGF-I administration in optimizing bone accrual in states of undernutrition associated with low IGF-I.

生长激素（GH）和胰岛素样生长因子-I（IGFI）是关键的骨营养激素，其在青春期的水平升高对青春期骨骼的生长至关重要。生长激素缺乏症和遗传抗性的状况有害地影响了皮质和小梁骨，降低了骨强度的估计值。在人类中，营养不足状况（如神经性厌食症（AN）或慢性病后）与低IGF-I水平相关，IGF-I水平与疾病严重程度相关，还与较低的骨矿物质密度（BMD），受损的骨骼结构相关和较低的强度估计。在青少年和成人AN中，研究表明，尽管GH浓度高，但其营养获得的GH抵抗性IGF-I水平较低。IGF-I水平随体重增加而上升，并与骨转换标志物水平上升有关。在持续6-10天的短期研究中，生理替代剂量的重组人IGF-I（rhIGF-I）给药可在患有AN的成人和青少年中使IGF-I水平正常化，并增加骨形成标志物的水平。在一项针对成人AN患者的随机对照试验中，参与者被随机分配到以下四个方面之一：（i）rhIGF-1与口服雌激素-孕酮（EP），（ii）rhIGF-1单独，（iii）EP单独或（iv）在这9个月中均未发现，在接受rhIGF-1的组中骨形成标志物显着增加，而在接受EP的组中骨吸收标志物显着下降。与未同时接受rhIGF-I和EP的组相比，同时接受rhIGF-I和EP的组的骨密度明显增加。副作用极小，没有记录到指尖葡萄糖<50 mg / dl。