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In this theory, reduced amounts of IGF-1 bioavailability would impact sebocyte proliferation via the loss of regulatory functions that IGF-1 has on 5-Reductase, while also causing impaired processing of secreted lipids in the interfollicular epidermis, which combined could result in the eventual keratinization of both the sebaceous gland and the impaired epithelial barrier of the follicular canal

doi:10.2337/db14-1577 11

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However, this study did not assess bone mineral density (DEXA) results or lifestyle factors such as physical activity and nutrition, which might moderate fracture risk