# Relationship Between Serum Nell‐1 Level and Bone Geometry, Bone Microarchitecture in Chinese Postmenopausal Women

## TL;DR

This study finds that higher serum Nell-1 levels in Chinese postmenopausal women are linked to better bone density and strength, suggesting a potential role in treating osteoporosis.

## Contribution

The study is the first to show a clinical correlation between serum Nell-1 levels and improved bone microarchitecture in postmenopausal women.

## Key findings

- Higher serum Nell-1 levels correlate with increased bone mineral density and bone strength in postmenopausal women.
- Elevated Nell-1 levels are associated with larger cortical area and thickness at the distal tibia.
- Nell-1 levels show a significant negative relationship with bone resorption marker β-CTX.

## Abstract

Neural EGF‐like 1 (Nell‐1), originally implicated in craniosynostosis, has been identified as a key regulator in osteogenic processes. While preclinical data were encouraging, clinical studies correlating serum Nell‐1 levels with osteoporosis remain scarce. This study aims to investigate the relationship between circulation Nell‐1 level and bone turnover markers, bone mineral density (BMD), bone microstructure, muscle strength, fall risk, and fractures in Chinese postmenopausal women.

Serum Nell‐1 levels were measured in 123 Chinese postmenopausal women. Muscle function was evaluated through grip strength tests, the Short Physical Performance Battery (SPPB), and the Timed Up and Go (TUG) test. Dual‐energy X‐ray absorptiometry was used to assess areal bone mineral density (aBMD), lumbar trabecular bone score (TBS), and muscle mass. High‐resolution peripheral quantitative computed tomography (HR‐pQCT) was applied to determine volumetric bone mineral density (vBMD), analyze bone microarchitecture, and estimate bone strength.

Postmenopausal women with higher serum Nell‐1 levels had higher aBMD and total volumetric bone mineral density (Tot.vBMD) at the distal tibia, larger cortical area (Ct.Ar) and thicker cortical thickness (Ct.Th) at the distal tibia, and higher bone strength. There was a significant negative association between serum Nell‐1 levels and C‐terminal cross‐linking telopeptide of type I collagen (β‐CTX), while no significant correlations were observed between serum Nell‐1 levels and muscle mass or function.

Postmenopausal women with higher serum Nell‐1 levels exhibited higher BMD and bone strength, indicating its potential as a therapeutic invention for osteoporosis.