Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
Spine Center, St. Marianna University Hospital, Kawasaki, Japan.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):425-431. doi: 10.1007/s00590-023-03678-9. Epub 2023 Aug 11.
To investigate longitudinal changes in bone mineral density (BMD) in middle-aged female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS).
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.
BMD decreased significantly from the initial (0.802 ± 0.120 g/cm) to the second survey (0.631 ± 0.101 g/cm; 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).
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.
研究接受脊柱融合术治疗青少年特发性脊柱侧凸（AIS）的中年女性患者的骨密度（BMD）的纵向变化。
本研究对象为 1968 年至 1988 年间诊断为 AIS 并接受脊柱融合术的 229 名女性患者。对 19 名 AIS 女性患者进行了两步式调查研究。比较了初始（2014-2016 年）和第二次（2022 年）调查之间的 BMD、Z 评分、T 评分以及骨质疏松症和骨量减少的患病率。分析了 Z 评分和 T 评分的年度变化与影像学参数、体重指数（BMI）和剩余活动椎间盘数量之间的相关性。
BMD 从初始（0.802±0.120 g/cm）显著降低至第二次调查（0.631±0.101 g/cm；p<0.001）。Z 评分从 0.12±1.09 降低至-0.14±1.04，而 T 评分则从-0.70±1.07 显著降低至-1.77±1.11（p<0.001）。骨量减少和骨质疏松症的患病率从 36.8%显著增加到 89.5%（p=0.002），但仅骨质疏松症的增加无统计学意义（5.3%增加至 26.3%；p=0.180）。Z 评分的年度变化与主胸（MT）曲线（r=-0.539；p=0.017）和腰椎曲线（r=-0.410；p=0.081）之间呈中度负相关。T 评分的年度变化与 MT 曲线呈中度负相关（r=-0.411；p=0.081）。
接受脊柱融合术治疗的中年女性 AIS 患者的 BMD 显著降低，且骨量减少和骨质疏松症的患病率增加。AIS 患者 Z 评分的下降表明与一般人群相比，BMD 加速丢失。较大的残余曲线可能会增加骨质疏松症的风险。需要进一步研究以了解 AIS 患者骨质疏松症的发生是归因于病情本身还是手术干预。
