Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 5/F, Clinical Science Building, Shatin, NT, Hong Kong SAR, China.
Spine J. 2013 Nov;13(11):1493-9. doi: 10.1016/j.spinee.2013.05.018. Epub 2013 Jun 18.
Adolescent idiopathic scoliosis (AIS) is associated with low bone mass that could persist into early adulthood and is an important prognostic factor for curve progression. Previous studies were confined to areal bone mineral density measurement that was a two-dimensional investigation for a three-dimensional structure. Evaluation of volumetric BMD (vBMD) and other bone quality parameters are important for gaining in-depth understanding of the etiopathogenesis of AIS.
The objective of this study was to carry out direct in vivo measurement of bone quality in AIS using high-resolution peripheral quantitative computed tomography (HR-pQCT) and compare the correlation of bone quality with osteopenia between AIS and control subjects.
STUDY DESIGN/SETTING: A case-control study.
Newly diagnosed AIS girls (n=112) and non-AIS girls (n=115) between 11 and 13 years.
Areal bone mineral density of bilateral femoral necks and HR-pQCT of the nondominant distal radius were performed.
Areal bone mineral density of femoral necks was measured by dual-energy X-ray absorptiometry. Subjects were classified into the osteopenic (Z score less than or equal to -1) and nonosteopenic (Z score more than -1) groups. Bone quality parameters, including bone morphometry, trabecular bone microarchitecture, and vBMD, were measured by HR-pQCT (XtremeCT; Scanco Medical, Zurich, Switzerland).
In AIS, the osteopenic group had lower measurements in cortical area, cortical thickness, average vBMD, compact bone vBMD, trabecular vBMD, trabecular bone volume to tissue volume ratio, and trabecular thickness compared with nonosteopenic AIS subjects. In contrast, among the non-AIS controls, the osteopenic group had lower measurements only in bone morphometry, average vBMD, and compact bone vBMD but not in trabecular vBMD and all other trabecular bone microarchitecture parameters.
This is the first study using HR-pQCT to compare the correlation of bone quality with osteopenia in AIS and non-AIS subjects. It provides new insights and highlights the unique bone quality profile with predominant changes in the trabecular compartment in association with osteopenia being notably only detected in the AIS subjects. Further studies in this area are warranted for defining the metabolic nature and biomechanical sequelae of derangement in bone mass and bone quality and their roles in the etiopathogenesis of AIS.
青少年特发性脊柱侧凸（AIS）与骨量低有关，这种情况可能会持续到成年早期，并且是曲线进展的一个重要预后因素。以前的研究仅限于面积骨密度（aBMD）的测量，这是一种针对三维结构的二维研究。评估容积骨密度（vBMD）和其他骨质量参数对于深入了解 AIS 的病因发病机制非常重要。
本研究旨在使用高分辨率外周定量计算机断层扫描（HR-pQCT）对 AIS 患者进行骨质量的直接体内测量，并比较 AIS 患者与对照组之间骨质量与骨质疏松症的相关性。
研究设计/设置：病例对照研究。
11-13 岁新诊断的 AIS 女孩（n=112）和非 AIS 女孩（n=115）。
双侧股骨颈的 aBMD 和非优势桡骨远端的 HR-pQCT。
通过双能 X 射线吸收法测量股骨颈的 aBMD。受试者分为骨质疏松组（Z 评分≤-1）和非骨质疏松组（Z 评分＞-1）。通过 HR-pQCT（XtremeCT；Scanco Medical，苏黎世，瑞士）测量骨质量参数，包括骨形态计量学、小梁骨微结构和 vBMD。
在 AIS 中，骨质疏松组的皮质面积、皮质厚度、平均 vBMD、皮质骨 vBMD、小梁骨 vBMD、小梁骨体积与组织体积比和小梁骨厚度的测量值均低于非骨质疏松 AIS 受试者。相比之下，在非 AIS 对照组中，骨质疏松组仅在骨形态计量学、平均 vBMD 和皮质骨 vBMD 方面的测量值较低，而在小梁骨 vBMD 和所有其他小梁骨微结构参数方面的测量值均较高。
这是第一项使用 HR-pQCT 比较 AIS 和非 AIS 受试者骨质量与骨质疏松症相关性的研究。它提供了新的见解，并强调了与骨质疏松症相关的以小梁骨隔室为主的独特骨质量特征，而这种特征仅在 AIS 受试者中明显检测到。需要在该领域进行进一步的研究，以确定骨量和骨质量紊乱的代谢性质和生物力学后果及其在 AIS 病因发病机制中的作用。
