Abstract
Generalized osteopenia and spinal deformity occur concomitantly in adolescent idiopathic scoliosis (AIS) during the peripubertal period. No large-scale study has been performed to reveal the link between scoliotic deformity and bone-mineral status in AIS. In a cross-sectional study, the extent of scoliotic-curve severity in relation to bone-mineral status was examined for 619 AIS girls and compared with those of 300 healthy non-AIS counterparts aged 11–16 years. Curve severity was categorized into a moderate (10–39°) and a severe group (≥40°) based on Cobb angle. Anthropometric parameters, bone mineral-density (BMD) and bone mineral-content (BMC) of lumbar spine, proximal femur and distal tibia were determined by dual-energy X-ray absorptiometry and peripheral QCT. Differences in anthropometric parameters and bone mass among control and the AIS-moderate and AIS-severe groups were tested by one-way ANOVA. Association between Cobb angle and bone mass was determined by univariate and multivariate analyses. Mean Cobb angle of the moderate and severe groups were 25±6.3° and 50.2±11.3°, respectively. Arm span and leg length among the moderate and severe AIS subjects were almost all longer than for the controls from age 13 years. Age-adjusted arm span and leg length were significantly correlated with curve severity ( p <0.015). Starting from age 13 years, most axial and peripheral BMD and BMC of the moderate or severe AIS group was significantly lower than for the controls ( p <0.029). Age-adjusted Cobb angle was inversely correlated with BMD and BMC of the distal tibia and lumbar spine among AIS subjects ( p ≤0.042). The proportion of osteopenic AIS girls in the severe group was significantly higher than that in the moderate group ( p ≤0.033). Multivariate analysis indicated that Cobb angle was inversely and independently associated with axial and peripheral BMD and BMC ( p ≤0.042). To conclude, curve severity was an inverse and independent associated factor on bone mineral mass of AIS during peripuberty. The study implied that prevention of osteopenia could be as important as controlling spinal progression in the management of AIS.
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References
Cook SD, Harding AF, Morgan EL, Nicholson RJ, Thomas KA, Whitecloud TS, Ratner ES (1987) Trabecular bone mineral density in idiopathic scoliosis J Pediatr Orthop 7:168–174
Snyder BD, Zaltz I, Breitenbach MA, Kido TH, Myers ER, Emans JB (1995) Does bracing affect bone density in adolescent scoliosis? Spine 20:1554–1560
Cheng JC, Guo X (1997) Osteopenia in adolescent idiopathic scoliosis. A primary problem or secondary to the spinal deformity? Spine 22:1716–1721
Cheng JC, Guo X, Sher AH (1999) Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow-up study. Spine 24:1218–1222
Cheng JC, Qin L, Cheung CS, Sher AH, Lee KM, Ng SW, Guo X (2000) Generalized low areal and volumetric bone mineral density in adolescent idiopathic scoliosis. J Bone Miner Res 15:1587–1595
Cheng JCY, Sher AHL, Guo X, Hung VWY, Cheung AY (2001) The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study. Hong Kong Med J 7:241–245
Lee WTK, Cheung CSK, Tse YK, Guo X, Qin L, Ho SC, Lau J, Cheng JCY (2005) Generalized low bone mass of girls with adolescent idiopathic scoliosis is related to inadequate calcium intake and weight-bearing physical activity in peripubertal period. Osteoporos Int 16(9):1024–1035
Stokes IA, Spence H, Aronsson DD, Kilmer N (1996) Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine 21:1162–1167
Stokes IA (1997) Analysis of symmetry of vertebral body loading consequent to lateral spinal curvature. Spine 22:2495–2503
Villemure I, Aubin CE, Dansereau J, Labelle H (2004) Biomechanical simulations of the spine deformation process in adolescent idiopathic scoliosis from different pathogenesis hypotheses. Eur Spine J 13:83–90
Cheung CSK, Lee WTK, Tse YK, Tang SP, Lee KM, Guo X, Qin L, Cheng JCK (2003) Abnormal peri-pubertal anthropometric measurements and growth pattern in adolescent idiopathic scoliosis—a study of 598 patients. Spine 28:2152–2157
Cheng JCY, Leung SSF, Chiu BSK, Tse PW, Lee CW, Chan AK, Xia G, Leung AK, Xu YY (1998) Can we predict body height from segmental bone length measurements? A study of 3,647 children. J Pediatr Orthop 18:387–393
Cheng JCY, Leung SSF, Lau J (1996) Anthropometric measurements and body proportions among Chinese children. Clin Orthop 323:22–30
Bjure J, Grimby G, Nachemson A (1968) Correction of body height in predicting spirometric values in scoliotic patients. Scand J Clin Lab Invest 21:191–192
Hans D, Biot B, Schott AM, Meunier PJ (1996) No diffuse osteoporosis in lumbar scoliosis but lower femoral bone density on the convexity. Bone 18:15–17
Rüegsegger P, Koller B, Muller R (1996) A microtomographic system for the nondestructive evaluation of bone architecture. Calcif Tissue Int 58:24–29
Rüegsegger P (1996) Bone density measurement. In: Bröll H, Dambacher MA (eds) Osteoporosis: A guide to diagnosis and treatment. Rheumatology. Karger, Basel, 18:103–116
Qin L, Au SK, Chan KM, Lau MC, Woo J, Dambacher MA, Leung PC (2000) Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong. Calcif Tissue Int 67:29–36
Hong Kong Department of Health (1997) Public health and epidemiology bulletin. Hong Kong, 6(2):1997
Department of Health, Hong Kong, SAR (2003–2004) Annual report. Government Printer, Hong Kong
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2000) Consensus Development Conference. NIH 17(1):1–45 [http://consensus.nih.gov/cons/111/111_intro_htm]
Lee WTK (1993) Requirements of calcium: Are there ethnic differences? Asia Pac J Clin Nutr 2:183–190
Lee WTK, Leung SSF, Wang SH, XU YC, Zeng WP, Lau J, Oppenheimer SJ, Cheng J (1994) Double-blind controlled calcium supplementation and bone mineral accretion in children accustomed to low calcium diet. Am J Clin Nutr 60:744–752
Lee WTK, Leung SSF, Leung DMY, Tsang HSY, Lau J, Cheng JCY (1995) A randomised double-blind controlled calcium supplementation trial, and bone and height acquisition in children. Br J Nutr 74:125–139
Lee WTK, Cheng JCY, Cheung CSK, Guo X, Ho S, Lau J (2003) Inadequate calcium intake is a significant determinant on generalised osteopenia in Hong Kong Chinese adolescents with idiopathic scoliosis. Wei Sheng Yan Jiu 32:568–572
Hueter C (1862) Anatomische Studien an den Extremitaetengelenken Neugeborener und Erwachsener. Virchows Arch Pathol Anat Physiol Klin Med 25:572–599
Volkmann R (1882) Verletzungen und Krankenheiten der Bewegungsorgane. In: von Pitha, Billroth (eds) Handbuch der allgemeinen und speciellen Chirurgie Bd II Teil II. Ferdinand Enke, Stuttgart
Arkin AM, Katz JF (1956) The effects of pressure on epiphyseal growth. The mechanism of plasticity of growing bone. J Bone Joint Surg Am 38:1056–1076
Gooding CA, Neuhauser EBD (1965) Growth and development of the vertebral body in the presence and absence of normal stress. AJR Am J Roentgenol 93:388–394
Hert J, Liskova M (1964) Regulation of the longitudinal growth of the long bone by mechanical influence. Acta Univ Carol Med 20 [Suppl]:32–34
Roaf R (1960) Vertebral growth and its mechanical control. J Bone Joint Surg Br 42:40–59
Velis KP, Healey JH, Schneider R (1989) Peak skeletal mass assessment in young adults with idiopathic scoliosis. Spine 14:706–711
Vanderpool DW, James JI, Wynne-Davies R (1969) Scoliosis in the elderly. J Bone Joint Surg Am 51:446–455
Healey JH, Lane JM (1985) Structural scoliosis in osteoporotic women. Clin Orthop 195:216–223
Cheung CSK, Lee WTK, Tse YK, Lee KM, Guo X, Qin L, Cheng JCY (2005) Generalized osteopenia in adolescent idiopathic scoliosis —association with abnormal pubertal growth, bone turnover and calcium intake? Spine (in press)
Acknowledgements
We would like to express our gratitude for the support from patients, healthy volunteers and their parents. Without their support, this study would not have been possible. We also thank Mr. Jacky W.W. Chau, Miss Vivian W.Y. Hung, Miss Christine Lee, and Miss Catherine Li for assistance in field work, and Dr. Simon K.M. Lee for going through the final manuscript. The study was supported by an Earmark Research Grant from the Research Grant Council (CUHK No. 4336/99), Hong Kong SAR, and a grant from the Health Service Research Committee / Health Care and Promotional Fund (HSRF No. 921024), Hong Kong SAR
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Lee, W.T.K., Cheung, C.S.K., Tse, Y.K. et al. Association of osteopenia with curve severity in adolescent idiopathic scoliosis: a study of 919 girls. Osteoporos Int 16, 1924–1932 (2005). https://doi.org/10.1007/s00198-005-1964-7
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DOI: https://doi.org/10.1007/s00198-005-1964-7