Since several physiologic variables cause major changes in IGF-I, this suggests that states of low IGF-I and high IGFBP-2 (such as malnutrition or advanced age) would have a low aBMD;33–35 whereas high IGF-I and high IGFBP-2 would be anabolic.36–38 Therefore, optimal use of this peptide may require selection of clinical conditions wherein there is maintenance of normal IGF secretion or pharmacologic manipulation to increase IGF production. The gene discussed is IGFBP2; the disease is malnutrition.