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Bone Metabolism in AIS

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Pathogenesis of Idiopathic Scoliosis

Abstract

Adolescent idiopathic scoliosis (AIS) occurs in children during their pubertal growth spurt. Rapid skeletal growth and abnormal anthropometric parameters are associated with the development and progression of scoliotic curves, with the curves stabilized when skeletal maturity is reached. Systemic osteopenia affecting multiple skeletal sites, defined as bone mineral density (BMD) of Z-score ≤ −1 with reference to the age and ethnic-matched population, was found by dual-energy X-ray absorptiometry (DXA) in over 30% of the AIS patients. The osteopenia could persist into adulthood, thus predisposing the AIS patients to osteoporosis and other related complications in later life. Osteopenia in AIS was shown to be an important prognostic factor for curve progression. Recent studies with advanced high-resolution peripheral quantitative computed tomography (HR-pQCT) revealed significant alterations in systemic bone geometry, micro-architecture, volumetric BMD, and mechanical bone strength (finite element analysis) in addition to osteopenia in AIS. Serological and cellular functional studies supported the presence of abnormal bone formation and resorption that might have contributed to the abnormal bone qualities and bone strength which could be linked to the etiopathogenesis of AIS. Physical activities, calcium and vitamin D intake, and genetics are important factors affecting bone mass in AIS. Recent RCT studies on whole-body vibration therapy and supplement therapy with calcium and vitamin D have shown to improve low bone mass in AIS significantly. A better understanding on the possible association between bone qualities and curve progression will shed light on future development of novel prognostic biomarkers and therapeutic strategies in AIS.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China

    Jack C. Y. Cheng, Wayne Y. W. Lee, Elisa M. S. Tam & T. P. Lam

  2. Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong, China

    Jack C. Y. Cheng, Wayne Y. W. Lee, Elisa M. S. Tam & T. P. Lam

Authors
  1. Jack C. Y. Cheng
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  2. Wayne Y. W. Lee
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  3. Elisa M. S. Tam
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  4. T. P. Lam
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Correspondence to Jack C. Y. Cheng .

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Editors and Affiliations

  1. Department of Spine and Spinal Cord Surgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan

    Masafumi Machida

  2. University of Iowa, Iowa, USA

    Stuart L. Weinstein

  3. Academie Nationale de Medecine, Paris, France

    Jean Dubousset

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Cheng, J.C.Y., Lee, W.Y.W., Tam, E.M.S., Lam, T.P. (2018). Bone Metabolism in AIS. In: Machida, M., Weinstein, S., Dubousset, J. (eds) Pathogenesis of Idiopathic Scoliosis. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56541-3_6

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