Association of higher bone turnover with risk of curve progression in adolescent idiopathic scoliosis

Zhang, Jiajun; Wang, Yujia; Cheng, Ka-lo; Cheuk, Kayee; Lam, Tsz-ping; Hung, Alec L. H.; Cheng, Jack C. Y.; Qiu, Yong; Müller, Ralph; Christen, Patrik; Lee, Wayne Y. W.

Affiliations

¹Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China

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

³Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China

⁴Institute for Biomechanics, ETH, Zurich, Zurich, Switzerland

⁵Institute for Information Systems, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Abstract and keywords

Objective: Emerging evidence suggest abnormal bone metabolism and defective bone qualities are associated to etipathogenesis of Adolescent Idiopathic Scoliosis (AIS). Systemic low bone mass is important prognosticator to predict risk of curve progression in AIS. The underlying mechanism is still unclear. We hypothesize that aberrant bone turnover correlates with bone qualities in AIS and associates to risk of curve progression.

Subjects and methods: Two cohorts were included in this study. The case-control study recruited 161 AIS girls and 161 ethnic/age-matched healthy girls. The longitudinal cohort recruited 128 AIS girls with two-year follow-up. Areal bone mineral density (BMD) at femoral necks were measured with dual-energy x-ray absorptiometry (DXA), and bone qualities of distal radius by high-resolution peripheral quantitative computed tomography (HR-pQCT). Time-lapse analysis of registered HR-pQCT images estimated local bone remodeling quantitatively. Serum levels of CTX and P1NP were measured with ELISA kits.

Results: AIS presented significantly higher serum level of P1NP. In both AIS and control, the negative correlations were consistently observed between serum CTX/P1NP levels and most cortical bone quality parameters after adjustment to age. Significant correlation between serum bone turnover markers and trabecular bone parameters have been observed only in control. Progressive AIS has significant increase of serum P1NP level at first clinic visit. Time lapse register analysis showed high bone resorption and low net bone gain was associated with risk of progression in AIS.

Conclusions: Our study characterized AIS with higher serum bone turnover markers, which may contribute to defective bone qualities in AIS. For the first time, we showed that progressive AIS had higher systemic bone turnover markers level and local bone remodeling. This fresh evidence indicated association between disrupted bone turnover and risk of progression of AIS, which set the foundation of new prognostic method and of novel treatment target to curve progression. This study demonstrated the importance of bone metabolism in developing disease management of AIS to achieve goal of early prediction and non-surgical modulation.

Keywords: Bone mineral density; Bone qualities; CTX; P1NP; curve progression

Links

DOI: 10.1016/j.bone.2020.115655

PubMed: 32979537

WoS: 000604733200005

History

Received: 2020-07-22

Revised: 2020-09-18

Accepted: 2020-09-18

Online: 2020-09-23

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Cited By (1)

Year	Entry
2023	Yang KG, Goff E, Cheng K-l, Kuhn GA, Wang Y, Cheng JC-y, Qiu Y, Müller R, Lee WY-w. Abnormal morphological features of osteocyte lacunae in adolescent idiopathic scoliosis: a large-scale assessment by ultra-high-resolution micro-computed tomography. Bone. January 2023;166:116594.