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Generalized low bone mass of girls with adolescent idiopathic scoliosis is related to inadequate calcium intake and weight bearing physical activity in peripubertal period

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Abstract

Generalized low bone mass has been well documented in patients with adolescent idiopathic scoliosis (AIS). However, studies linking calcium-intake (CA), weight-bearing physical-activity (PA) and bone mass of AIS are lacking. We aimed to study the relationship between CA, PA and bone mass in AIS girls and compared to those of healthy non-AIS controls during the peripubertal period. Newly diagnosed AIS girls (n=596) aged 11–16 years with Cobb angle ≥10° were recruited to compare with age-matched healthy girls (n=302) in a cross-sectional study. Anthropometric parameters, pubertal status, CA and PA were assessed. Areal bone mass of lumbar spine and femoral neck, and volumetric bone mass of distal radius and tibia were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. The results showed that weight and body mass index (BMI) of AIS were lower than the controls (P<0.05). Corrected height and arm span of AIS were longer than those of controls from 13 years onwards (P<0.02). Median CA of AIS was <410 mg/day across the ages and did not differ from the controls (P=0.063). Median PA of AIS (1.6 h/day) was lower than the controls (1.8 h/day) (P=0.025). Bone mass of AIS was on average 6.5% lower than controls across the ages (P<0.05). CA and PA were significantly correlated with bone mass of AIS (P<0.04). Multivariate analysis showed that AIS in girls was associated with lower bone mass, and that both CA and PA were independent predictors of bone mass in AIS. In conclusion, AIS girls were found to have lower body weight and BMI, longer segmental lengths and generalized low bone mass. Inadequate calcium intake and weight-bearing physical activity were significantly associated with low bone mass in AIS girls during the peripubertal period. The importance of preventing generalized osteopenia in the control of AIS progression during the peribubertal period warrants further study.

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References

  1. Roaf R (1996) The basic anatomy of scoliosis. J Bone Joint Surg [Br]. 48:786–792

    Google Scholar 

  2. Somerville EW (1952) Rotational lordosis: the development of the single curve. J Bone Joint Surg [Br] 34:421–427

    Google Scholar 

  3. Burwell RG, Dangerfield PH, Lowe TG (eds) (2000) Etiology of adolescent idiopathic scoliosis–spine: state of the art reviews 14 (2). Hanley & Belfus, Philadelphia

  4. Miller NH (2001) Adolescent idiopathic scoliosis: etiology. In: Weinstein SL 2nd (ed) The pediatric spine: principles and practice. Lippincott Williams & Wilkins, Philadelphia, pp 347–354

  5. Cook SD, Harding AF, Morgan EL, Nicholson RJ, Thomas KA, Whitecloud TS, Ratner ES (1987) Trabecular bone mineral density in idiopathic scoliosis. J Pediatr Orthop 7:168–174

    Google Scholar 

  6. Thomas KA, Cook SD, Skalley TC (1992) Lumbar spine and femoral mineral density in idiopathic scoliosis: a follow up study. J Pediatr Orthop 12:235–240

    Google Scholar 

  7. Snyder BD, Zaltz I, Breitenbach MA, Kido TH, Myers ER, Emans JB (1995) Does bracing affect bone density in adolescent scoliosis? Spine 20:1554–1560

    CAS  PubMed  Google Scholar 

  8. Cheng JCY, Guo X (1997) Osteoporosis in adolescent idiopathic scoliosis, a primary problem or secondary to the spinal deformity? Spine 22:1716–1721

    CAS  PubMed  Google Scholar 

  9. Cheng JCY, Guo X, Sher AHL (1998) Adolescent idiopathic scoliosis associated low bone mineral density. Chin J Orthop 18:332–334

    Google Scholar 

  10. Cheng JC, Qin L, Cheung CS, Sher AH, Lee KM, Ng SW, Guo X (2000) Generalized low areal and volumetric bone mineral density in adolescent idiopathic scoliosis. J Bone Miner Res 15:1587–1595

    CAS  PubMed  Google Scholar 

  11. Cheng JC, Tang SP, Guo X, Chan CW, Qin L (2001) Osteopenia in adolescent idiopathic scoliosis: a histomorphometric study. Spine 26:E19–23

    CAS  PubMed  Google Scholar 

  12. Cheng JC, Guo X, Sher AH (1999) Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow up study. Spine 24:1218–1222

    CAS  PubMed  Google Scholar 

  13. Johnston CC, Miller JZ, Slemenda CW, Reister TK, Hui S, Christian JC, Peacock M (1992) Calcium supplementation and increases in bone mineral density in children. New Engl J Med 327:82–87

    PubMed  Google Scholar 

  14. Lloyd T, Andon MB, Rollings N, Martel J K, Landis JR, Demers LM, Eggli DF, Kieselhorst K, Kulin HE (1993) Calcium supplementation and bone mineral density in adolescent girls. JAMA 270:841–844.

    Article  CAS  PubMed  Google Scholar 

  15. Lee WTK, Leung SSF, Wang SH, XU YC, Zeng WP, Lau J, Oppenheimer SJ, Cheng J (1994) Double-blind controlled calcium supplementation and bone mineral accretion in children accustomed to low calcium diet. Am J Clin Nutr 60:744–752

    CAS  PubMed  Google Scholar 

  16. Lee WTK, Leung SSF, Leung DMY, Tsang HSY, Lau J & Cheng JCY (1995) A randomised double-blind controlled calcium supplementation trial, and bone and height acquisition in children. Bri J Nutr 74:125–139

    CAS  Google Scholar 

  17. Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD (1997) Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res 12:1453–1462

    CAS  PubMed  Google Scholar 

  18. Cheng JCY, Leung SSF, Lee WT, Lau JTF, Maffulli N, Cheung AYK, Chan KM (1998) Determinants of axial and peripheral bone mass in Chinese adolescents. Arch Dis Child 78:524–530

    Google Scholar 

  19. Fuchs RK, Bauer JJ, Snow CM (2001) Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res 16:148–156.

    CAS  PubMed  Google Scholar 

  20. Stear SJ, Prentice A, Jones SC, Cole TJ (2003) Effect of a calcium and exercise intervention on the bone mineral status of 16–18 years-old adolescent girls. Am J Clin Nutr 77:985–992

    CAS  PubMed  Google Scholar 

  21. Lee WTK, Cheung AYK, Lau JTF, Lee SKM, Ling Qin, Cheng JCY (2004) Bone densitometry: which skeletal sites are best predicted by bone mass determinants. J Bone Miner Metab 22:447–456.

    Google Scholar 

  22. Iuliano-Burns S, Saxon L, Naughton G, Gibbons K, Bass SL (2003) Regional specificity of exercise and calcium during skeletal growth in girls: a randomized controlled trial. J Bone Miner Res 18:156–162

    PubMed  Google Scholar 

  23. Tanner JM (1962) Growth at adolescence, 2nd edition. Blackwell Scientific, Oxford

  24. Lee WTK, Leung SSF, Leung DMY, Cheng JCY (1996). A follow-up study on the effects of calcium-supplement withdrawal and puberty on bone acquisition of children. Am J Clin Nutr 164:71–77

    Google Scholar 

  25. Leung MY (2003) Validation of food frequency questionnaire for calcium intake in Hong Kong Children. MSc (Epidemiology & Biostatistics) thesis, The Chinese University of Hong Kong

  26. Slemenda CW, Miller JZ, Hui SL, Reister TK, Johnston CC (1991) Role of physical activity in the development of skeletal mass in children. J Bone Miner Res 6:1227–1233

    CAS  PubMed  Google Scholar 

  27. Genant HK, Block JE, Steiger P, Glueer CC, Ettinger B, Harris ST (1989) Appropriate use of bone densitometry. Radiology 170:817–822

    CAS  PubMed  Google Scholar 

  28. Qin L, Au S, Choy W, Leung P, Neff M, Lee K, Lau M, Woo J, Chan K (2002) Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: a case-control study. Arch Phys Med Rehabil 83:1355–1359

    PubMed  Google Scholar 

  29. Qin L, Au SK, Chan KM, Lau MC, Woo J, Dambacher M, Leung PC (2000) Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong. Calcif Tissue Int 67:29–36

    CAS  PubMed  Google Scholar 

  30. Rüegsegger P (1996) Bone density measurement. Rheumatology 18:103–116

    Google Scholar 

  31. Chinese Nutrition Society (2000) Chinese dietary reference intakes. Chinese Light Industry Press, Beijing

  32. King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg [Am] 65:1302–1313

    Google Scholar 

  33. Velis KP, Healey JH (1989) Schneider R. Peak skeletal mass assessment in young adults with idiopathic scoliosis. Spine 14:706–711

    CAS  PubMed  Google Scholar 

  34. Cheng JC, Leung SS, Lee WT, Lau JT, Maffulli N, Cheung AY, Chan KM (1998) Determinants of axial and peripheral bone mass in Chinese adolescents. Arch Dis Child 78:524–530

    Google Scholar 

  35. Cheung CSK, Lee WTK, Tse YK, Tang SP, Lee KM, Guo X, Qin L, Cheng JCK (2003) Abnormal peri-pubertal anthropometric measurements and growth pattern in adolescent idiopathic scoliosis—a study of 598 patients. Spine 28:2152–2157

    PubMed  Google Scholar 

  36. Cheung CSK, Lee WTK, Guo X, Tang SP, Lee SKM, Cheng JCY (2002) Abnormal bone turnover in adolescent girls with idiopathic scoliosis. J Bone Miner Res 17:S219

    Google Scholar 

  37. Vanderpool DW, James JI, Wynne-Davies R (1969) Scoliosis in the elderly. J Bone Joint Surg 51A:446–455

    Google Scholar 

  38. Healey JH, Lane JM Structural scoliosis in osteoporotic women (1985) Clin Orthop 195:216–223

    PubMed  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to the patients and their parents, the Heads of school, students and parents from the participating schools; without their supports, our study would not have been successful. Thanks are also due to Mr. Jacky W.W. Chau, Miss Vivian Hung, Miss Christine Lee, Miss Catherine Li, Miss Sylvia Lam, Miss Elaine Au and Mr. Jason So for fieldwork assistance and data entry. Special thanks are also expressed to the Jockey Club Centre for Osteoporosis Care & Control, The Chinese University of Hong Kong for generous manpower support on this study. The study was supported by Research Grant Council (no. CUHK 4336/99M) & Health Service Research Grant (no. HSRF 921024), Hong Kong SAR.

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Authors and Affiliations

  1. Department of Orthopaedics & Traumatology, 5/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

    Warren T. K. Lee, Catherine S. K. Cheung, Ling Qin & Jack C. Y. Cheng

  2. Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong

    Warren T. K. Lee, Ling Qin & Jack C. Y. Cheng

  3. Centre for Epidemiology and Biostatistics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Yee Kit Tse & Joseph Lau

  4. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong

    Xia Guo

  5. Department of Community and Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Suzanne C. Ho

  6. Centre of Research and Promotion of Women’s Health, School of Public Health, The Chinese University of Hong Kong, Hong Kong

    Suzanne C. Ho

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  1. Warren T. K. Lee
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  2. Catherine S. K. Cheung
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  3. Yee Kit Tse
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  4. Xia Guo
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  5. Ling Qin
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  6. Suzanne C. Ho
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  7. Joseph Lau
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  8. Jack C. Y. Cheng
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Correspondence to Jack C. Y. Cheng.

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Lee, W.T.K., Cheung, C.S.K., Tse, Y.K. et al. Generalized low bone mass of girls with adolescent idiopathic scoliosis is related to inadequate calcium intake and weight bearing physical activity in peripubertal period. Osteoporos Int 16, 1024–1035 (2005). https://doi.org/10.1007/s00198-004-1792-1

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  • DOI: https://doi.org/10.1007/s00198-004-1792-1

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