MAPK signaling pathway is an important pathway that regulates the proliferation and differentiation of osteoclasts and osteoblasts, and can also promote the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), accelerate calcium deposition, and prevent the occurrence of osteoporosis.[41] The high insulin status of PCOS patients leads to abnormal activation of MAPK signaling pathway, which affects the growth and differentiation of ovarian granulosa cells. Here, INS is linked to osteoporosis.