School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Bone. 2020 Apr;133:115217. doi: 10.1016/j.bone.2019.115217. Epub 2019 Dec 28.
Low bone mineral status has been reported in patients first presented with adolescent idiopathic scoliosis (AIS). We aimed to study whether low-normal bone mineral density (BMD) is persistent among AIS girls during puberty and at peak bone mass, and whether if such persistence is associated with curve severity and differed from healthy controls.
This prospective longitudinal study comprised 550 AIS girls and 194 healthy control subjects followed from 1997 till 2016. Low-normal BMD was defined as z-standardized bone mineral density (z-BMD) of bilateral femoral neck ≤ -1. Markov Chain 2-stages analysis was conducted to investigate the low-normal BMD transition rate. Linear mixed-effects model and Bland-Altman plot were used to investigate whether low-normal BMD is persistent among a subgroup of AIS patients that reached peak bone mass.
The average z-BMD were comparable between AIS cohort and controls at 11 years old (-0.532 vs -0.602), but at 19 years old z-BMD worsened among AIS subjects (-0.860) while controls z-BMD improved (-0.455). During growth period until skeletal maturity, persistence of low-normal BMD was high in both cohorts (>80%) and the AIS group with severe curve presented 100% persistence. Subgroup analysis revealed that z-BMD of AIS patients at skeletal maturity and peak bone mass were highly correlated (r = 0.905) and with good agreement.
AIS patients had poorer BMD that is associated with curve severity and more likely to persist beyond peripubertal period and at peak bone mass when compared to controls.
研究初诊为青少年特发性脊柱侧凸（AIS）患者的骨矿物质状态较低是否在青春期和骨峰值期持续存在，以及这种持续性是否与曲线严重程度相关，是否与健康对照组存在差异。
本前瞻性纵向研究纳入了 550 名 AIS 女孩和 194 名健康对照组，随访时间从 1997 年至 2016 年。低骨密度定义为双侧股骨颈 z 标准化骨密度（z-BMD）≤-1。采用 Markov 链两阶段分析来评估低骨密度的转化率。采用线性混合效应模型和 Bland-Altman 图来评估在达到骨峰值的 AIS 患者亚组中，低骨密度是否持续存在。
在 11 岁时，AIS 组和对照组的平均 z-BMD 相似（-0.532 对-0.602），但在 19 岁时，AIS 组的 z-BMD 恶化（-0.860），而对照组的 z-BMD 改善（-0.455）。在生长期间直到骨骼成熟，两组的低骨密度持续率都很高（>80%），且严重曲线的 AIS 组具有 100%的持续率。亚组分析显示，骨骼成熟和骨峰值时 AIS 患者的 z-BMD 高度相关（r=0.905），且一致性良好。
与对照组相比，AIS 患者的骨矿物质密度较差，且与曲线严重程度相关，更有可能在青春期后和骨峰值期持续存在。
