Figure - available from: European Spine Journal
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Forest plots of volumetric bone mass density (vBMD). a Total vBMD. b Cortical vBMD. c Trabecular vBMD
Source publication
Purpose:
Osteoporosis is a risk factor for idiopathic scoliosis (IS) progression, but it is still unclear whether IS patients have bone mineral density (BMD) loss and a higher risk of osteoporosis than asymptomatic people. This systematic review aims to explore the differences in BMD and prevalence of osteoporosis between the IS group and the cont...
Citations
... In adolescence, the chief roles of progesterone are to influence the development of long-term memory, including central pattern generators within the central nervous system [17], as well as mediate the signaling of peak bone mass development as a child nears skeletal maturity [18]. Since disturbances in both functions are more common in idiopathic scoliosis [19][20][21], continued investigations into more detailed associations between progesterone and idiopathic scoliosis are reasonable and warranted. The dosage did appear to minimally influence the decrease in curve progression within the treatment group, as seen in Figures 11 and 12, but the small number of participants makes it difficult to extrapolate this trend to a larger population. ...
... In adolescence, the chief roles of progesterone are to influence the development of longterm memory, including central pattern generators within the central nervous system [17], as well as mediate the signaling of peak bone mass development as a child nears skeletal maturity [18]. Since disturbances in both functions are more common in idiopathic scoliosis [19][20][21], continued investigations into more detailed associations between progesterone and idiopathic scoliosis are reasonable and warranted. The dosage did appear to minimally influence the decrease in curve progression within the treatment group, as seen in Figures 11 and 12, but the small number of participants makes it difficult to extrapolate this trend to a larger population. ...
Background: Differences in hormone metabolism have been observed in children with adolescent idiopathic scoliosis. These differences have been offered as underlying reasons for rapid curve progression during puberty. This study retrospectively compared two groups of females with a history of adolescent idiopathic scoliosis. They were seen for initial presentation prior to menarche, or within 2 months after menarche, and they were followed up 1 year after first menarche. Methods: All patients in both groups underwent baseline salivary hormone testing to identify any hormone imbalances. The control group was composed of females with curves between 10 and 25 degrees and maintained an observation-only management strategy. The treatment group showed baseline curve measurements ranging from 10 to 23 degrees, and additionally took pregnenolone daily for 12 months. Results: At one-year follow-up, the treatment group showed curve measurements ranging from 13 to 24 degrees, while the control group ranged from 16 to 29 degrees (p < 0.05). Conclusions: The study showed that adolescent females taking pregnenolone daily for low progesterone had reduced scoliosis curve progression over 1 year compared to controls.
... BMD is represented by the BMD T-score [13]. Osteopenia has a T-score between 1.0 and 2.5, whereas osteoporosis possesses a T-score of 2.5 or less [14,15]. ...
... Scoliosis and osteoporosis may co-exists, with several reports describing a correlation between the two diseases both in adolescents and adults [9,10]. The presence of loading imbalance between the two limbs due to scoliosis has been reported [11,12]. ...
Purpose
Scoliosis is a cause of loading imbalance between the lower limbs, which can result in BMD differences between the two femurs. We investigated the discrepancy in BMD values assessed by quantitative computed tomography (QCT) between femurs in patients with and without scoliosis, also assessing if this difference can be related to spine convexity.
Methods
Abdominal CT examinations were retrospectively reviewed. An ‘‘asynchronous’’ calibration of CT images was performed to obtain BMD values from QCT. Scoliosis was evaluated on the antero-posterior CT localizer to calculate the Cobb angle. Differences between aBMD and vBMD of femurs were assessed in both scoliotic and non-scoliotic subjects.
Results
Final study cohort consisted of 263 subjects, 225 of them without scoliosis (85.6%) and 38 with scoliosis (14.4%). No significant differences were found in the general population without scoliosis, except for vBMD at the neck. Comparison of femurs in scoliotic patients showed statistically significant differences at neck aBMD −0.028 g/cm², p = 0.004), total femur aBMD (−-0.032 g/cm², p = 0.008) and total femur vBMD (−-8.9 mg/cm³, p = 0.011), with lower BMD values on the convexity side. In 10 cases (26%) a change in the final T-score diagnosis was observed.
Conclusion
QCT analysis demonstrated a difference in both areal and volumetric BMD between the two femurs of scoliotic patients, in relation to the side of the scoliotic curve. If these data will be confirmed by larger studies, bilateral femoral DXA acquisition may be proposed for these patients.
... This suggests that larger residual scoliosis curves following surgery may potentially contribute to a higher risk of osteoporosis progression in middle age. Past meta-analyses have reported lower BMD and a higher prevalence of osteopenia and osteoporosis in adolescents with AIS compared to controls [8]. The reported rates of osteopenia in patients with AIS aged 10-20 years ranged from 27 to 59% [9][10][11][12][13][14]. ...
Purpose
To investigate longitudinal changes in bone mineral density (BMD) in middle-aged female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS).
Methods
The study subjects were 229 female patients who were diagnosed with AIS and underwent spinal fusion between 1968 and 1988. A two-step survey study was conducted on 19 female AIS patients. BMD, Z-scores, T-scores, and the prevalence of osteoporosis and osteopenia were compared between the initial (2014–2016) and second (2022) surveys. Correlations between the annual changes in Z-scores and T-scores with radiographic parameters, body mass index (BMI), and the number of remaining mobile discs were analyzed.
Results
BMD decreased significantly from the initial (0.802 ± 0.120 g/cm²) to the second survey (0.631 ± 0.101 g/cm²; p < 0.001). Z-scores decreased from 0.12 ± 1.09 to − 0.14 ± 1.04, while T-scores decreased significantly from − 0.70 ± 1.07 to − 1.77 ± 1.11 (p < 0.001). The prevalence of osteopenia and osteoporosis increased significantly from 36.8% to 89.5% (p = 0.002), but the increase in osteoporosis alone was not statistically significant (5.3% to 26.3%; p = 0.180). Moderate negative correlations were found between annual changes in Z-scores and both main thoracic (MT) curve (r = − 0.539; p = 0.017) and lumbar curve (r = − 0.410; p = 0.081). The annual change in T-scores showed a moderate negative correlation with the MT curve (r = − 0.411; p = 0.081).
Conclusion
Significant reductions in BMD and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population. Larger residual curves could pose an added osteoporosis risk. Further research is needed to understand if the onset of osteoporosis in AIS patients is attributable to the condition itself or the surgical intervention.
... A previous review by Normand et al. [6] showed that idiopathic scoliosis patients had not only lower levels of vitamin D, but also calcitonin and parathyroid hormone. These findings offer potential explanations as to why idiopathic scoliosis patients also have lower average bone density than their peers [7]. Selenium is an essential trace mineral that serves as a cofactor for several enzymes involved in antioxidant defense mechanisms and bone metabolism. ...
... Considering that idiopathic scoliosis patients have lower bone density [7], the synergistic effects of melatonin, strontium, vitamin D, and vitamin K2 have been shown to increase bone density by improving osteoblastic signaling [28]. This is yet another potential role for functional medicine therapies at improving the underlying components of the idiopathic scoliosis cascade. ...
Addressing the underlying components of idiopathic scoliosis, including hormone and neurotransmitter imbalances, has the potential to improve scoliosis treatment outcomes. While the precise relationship between these imbalances and scoliosis development is not fully understood, emerging evidence suggests that correcting these imbalances may positively influence the progression and management of idiopathic scoliosis. The functional medicine model of patient evaluation and treatment may offer some insight as to more robustly, and possibly effectively, manage the entire idiopathic scoliosis condition. This review describes many of the known underlying abnormalities associated with idiopathic scoliosis and offers perspective and ideas for future research into comprehensive idiopathic scoliosis management.
Introduction
Observational studies have yielded inconsistent findings regarding the correlation between bone mineral density (BMD) and various spinal disorders. To explore the relationship between total-body BMD and various spinal disorders further, we conducted a Mendelian randomization analysis to assess this association.
Methods
Two-sample bidirectional Mendelian randomization (MR) analysis was employed to investigate the association between total-body BMD and various spinal disorders. The inverse-variance weighted (IVW) method was used as the primary effect estimate, and additional methods, including weighted median, MR-Egger, simple mode, and weighted mode, were used to assess the reliability of the results. To examine the robustness of the data further, we conducted a sensitivity analysis using alternative bone-density databases, validating the outcome data.
Results
MR revealed a significant positive association between total-body BMD and the prevalence of spondylosis and spinal stenosis. When total-body BMD was considered as the exposure factor, the analysis demonstrated an increased risk of spinal stenosis (IVW odds ratio [OR] 1.23; 95% confidence interval [CI], 1.14–1.32; P < 0.001) and spondylosis (IVW: OR 1.24; 95%CI, 1.16–1.33; P < 0.001). Similarly, when focusing solely on heel BMD as the exposure factor, we found a positive correlation with the development of both spinal stenosis (IVW OR 1.13, 95%CI, 1.05–1.21; P < 0.001) and spondylosis (IVW OR 1.10, 95%CI, 1.03–1.18; P = 0.0048). However, no significant associations were found between total-body BMD and other spinal disorders, including spinal instability, spondylolisthesis/spondylolysis, and scoliosis (P > 0.05).
Conclusion
This study verified an association of total-body BMD with spinal stenosis and with spondylosis. Our results imply that when an increasing trend in BMD is detected during patient examinations and if the patient complains of numbness and pain, the potential occurrence of conditions such as spondylosis or spinal stenosis should be investigated and treated appropriately.
