The role of serum TGF-beta isoforms as potential markers of osteoporosis

Osteoporosis is a major public health problem characterized by low bone min eral density (BMD) that presently has no biochemical test useful for its di agnosis. The cytokine TGF-beta has been postulated to play a role in contro lling bone density by regulating the fine balance between bone matrix depos ition by osteoblasts and its resorption by osteoclasts. We explored whether measurement of serum levels of different TGF-beta isoforms could be useful as a clinical tool in osteoporosis, We measured the concentration of TGF-b eta 1 antigen using the BDA19 capture sandwich enzyme-linked immunosorbent assay (ELISA), TGF-beta 2 antigen concentration using a Quantikine sandwich ELISA kit and TGF-beta 3 antigen concentration using a modified version of the TGF-beta 1 Quantikine sandwich ELISA kit. Subjects were 41 women with osteoporosis (with nontraumatic vertebral fracture or lumbar spine BMD Z-sc ore < - 1.5 SD) and a total of 199 control women from different sources. Se rum concentrations of TGF-beta 1 and TGF-beta 2 were similar in all groups. However, detectable levels of TGF-beta 3 (>0.2 ng/ml) were found in 35 of 41 patients with osteoporosis (median 7.2 (5.2-8.9) ng/ml) compared with 11 of 36 controls or 24 of 89 healthy women of unknown bone density. Differen ces among the groups could not be accounted for by age, weight, medications , use of hormone replacement therapy or the presence of osteoarthritis. Usi ng the optimal cut-off of greater than or equal to 2 ng/ml, the test was ab le to detect an individual with low spine BMD (Z-score < - 1.5) with a sens itivity of 84% and a specificity of 53%, with similar results for the femor al neck. The odds ratio for osteoporosis associated with a positive test at this level was 5.93 (95% CI 2.41-11.59), and 4.1 (95% CI 1.66-10.11) using the WHO cut-off of T-score < - 2.5. Serum TGF-beta 3 concentration is rais ed in osteoporotic women and the test appears to have potential as a marker for osteoporosis. The underlying mechanisms and the relationships between TGF-beta 3 and bone turnover and fractures remain to be explored.