Significant correlations for bone mineral density and bone microstructure between spinal and non-spinal skeletal sites (distal radius and proximal femur) in adolescent idiopathic scoliosis (AIS) patients were observed, indicating that proximal femoral DXA and distal radial HR-pQCT could provide valid clinical assessments in patients with AIS.
Low bone mass is an important feature of adolescent idiopathic scoliosis (AIS), which is a complex 3D spinal deformity that affects girls during puberty. However, no clinical imaging modality is suitable for regular monitoring on their spinal bone qualities in rapid growth period. Therefore, we investigated whether bone mineral density (BMD) and bone microstructure at non-spinal sites correlated with BMD and mechanical property in the spine in AIS patients.
Thirty-two AIS girls (16.7 ± 3.5 years old with mean Cobb angle of 67 ± 11°) who underwent pre-operative spine CT examination for navigation surgery were recruited. Volumetric BMD (vBMD) of lumbar spine (LS) was measured by quantitative computed tomography (QCT), vBMD and bone microstructure of distal radius (DR) by high-resolution peripheral QCT (HR-pQCT) and areal BMDs of total hip (TH) and femoral necks (FN) by dual-energy X-ray absorptiometry (DXA). Biomechanical properties of the DR and LS were estimated by finite element analysis (FEA). Pearson correlation was performed to study the correlation between bone parameters at these three sites.
LS vBMD correlated significantly with both FN and TH aBMD (R = 0.663–0.725, both p < 0.01) and with DR microstructural parameters (R = 0.380–0.576, all p < 0.05). Mechanical properties of LS and DR were also correlated (R = 0.398, p = 0.039).
Bone measurement at proximal femur and distal radius could provide an additional predictive power in estimating the bone changes at spine, which is the primary site of deformity in AIS patients. Our result indicated that DXA and HR-pQCT could provide a valid surrogate for spine bone measurements in AIS patients.
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This study was supported by the Research Grants Council of Hong Kong S.A.R., China (Project Nos. 463113 and 14163517) and the National Natural Science Foundation of China (NSFC) and the Research Grants Council (RGC) of Hong Kong Joint Research Scheme (Project No. N_CUHK416/16).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Joint Chinese University of Hong Kong–New Territories East Cluster Clinical Research Ethics Committee (CREC-2013.386) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants and their parents (if patients aged less than 18 years old) before entering the study.
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Cheuk, K.Y., Hu, Y., Tam, E.M.S. et al. Bone measurements at multiple skeletal sites in adolescent idiopathic scoliosis—an in vivo correlation study using DXA, HR-pQCT and QCT. Arch Osteoporos 14, 70 (2019). https://doi.org/10.1007/s11657-019-0621-2
- Adolescent idiopathic scoliosis
- Bone microstructure
- Bone mechanical property
- Quantitative computed tomography
- Finite element analysis