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Defining the bone morphometry, micro-architecture and volumetric density profile in osteopenic vs non-osteopenic adolescent idiopathic scoliosis

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Abstract

Purpose

Osteopenia has been widely reported in about 30 % of girls with adolescent idiopathic scoliosis (AIS). However, the bone quality profile of the 70 % non-osteopenic AIS defined by areal bone mineral density (BMD) with conventional dual-energy X-ray absorptiometry (DXA) has not been adequately studied. Our purpose was to verify whether abnormal volumetric BMD (vBMD) and bone structure (morphometry and micro-architecture) also existed in the non-osteopenic AIS when compared with matched controls using both DXA and high-resolution peripheral computed tomography (HR-pQCT).

Methods

This was a case–control cross-sectional study. 257 AIS girls with a mean age of 12.7 (SD = 0.8) years old and 187 age- and gender-matched normal controls with an average age of 12.9 (SD = 0.5) years old were included. Areal BMD (aBMD) and bone quality were measured with standard DXA and HR-pQCT, respectively. The parameters of HR-pQCT could be categorized as bone morphometry, vBMD and bone micro-architecture. The results were compared between the osteopenic AIS and osteopenic control, and between the non-osteopenic AIS and non-osteopenic control.

Results

In addition to the lower aBMD and vBMD, osteopenic AIS showed significantly greater cortical perimeter and trabecular area than the osteopenic control even after adjustments of age (P < 0.05). Non-osteopenic AIS also showed significantly lower aBMD together with lower cortical area, thickness and vBMD than the non-osteopenic control (P < 0.05). After adjustments of age, cortical area and vBMD, and trabecular number and separation continued to show statistical significance (P < 0.05). Both the osteopenic and non-osteopenic AIS subgroups revealed significant abnormal bone quality parameters from that in the control group after adjustments of age and aBMD with multi-linear regression analysis (P < 0.05).

Conclusions

The present study specifically defined the abnormal profile of bone quality in the osteopenic and non-osteopenic AIS for the first time. Both the osteopenic and non-osteopenic AIS were likely to have relatively lower bone mineral status and abnormal bone morphometry, micro-architecture and volumetric density profile compared with their normal matched controls. The observed abnormalities were suggestive of decreased endocortical bone apposition or active endocortical resorption that could affect the mechanical bone strength in AIS. The underlying pathomechanism might be attributed to abnormal bone modeling/remodeling that could be associated with the etiopathogenesis of AIS.

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Acknowledgments

This study is supported by Research Grants Council of the Hong Kong S.A.R., China (Project no: 463113 and 468809).

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

    Zhi-Wei Wang, Wayne Yuk-Wai Lee, Tsz-Ping Lam, Benjamin Hon-Kei Yip, Fiona Wai-Ping Yu, Wing-Sze Yu, Bobby Kin-Wah Ng & Jack Chun-Yiu Cheng

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

    Zhi-Wei Wang, Wayne Yuk-Wai Lee, Tsz-Ping Lam, Fiona Wai-Ping Yu, Feng Zhu, Bobby Kin-Wah Ng, Yong Qiu & Jack Chun-Yiu Cheng

  3. SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Zhi-Wei Wang, Wayne Yuk-Wai Lee, Tsz-Ping Lam, Fiona Wai-Ping Yu, Bobby Kin-Wah Ng & Jack Chun-Yiu Cheng

  4. Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Zhi-Wei Wang

  5. Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China

    Feng Zhu & Yong Qiu

Authors
  1. Zhi-Wei Wang
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  2. Wayne Yuk-Wai Lee
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  3. Tsz-Ping Lam
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  6. Wing-Sze Yu
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  7. Feng Zhu
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  9. Yong Qiu
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  10. Jack Chun-Yiu Cheng
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Corresponding author

Correspondence to Jack Chun-Yiu Cheng.

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Wang, ZW., Lee, W.YW., Lam, TP. et al. Defining the bone morphometry, micro-architecture and volumetric density profile in osteopenic vs non-osteopenic adolescent idiopathic scoliosis. Eur Spine J 26, 1586–1594 (2017). https://doi.org/10.1007/s00586-016-4422-7

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