Bone Mineral Density and Physical Performance of Female Patients 27 Years or Longer after Surgery for Adolescent Idiopathic Scoliosis

Abstract

Study DesignRetrospective cohort study.PurposeTo assess bone mineral density (BMD) and bone metabolism ≥27 years after surgery in female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) during adolescence and to determine their associations with physical performance. Overview of LiteratureThere are no studies investigating postsurgical BMD in middle-aged AIS patients.MethodsThis study included 23 patients who provided informed consent among 229 female patients with AIS who underwent spinal fusion from 1968 until 1988. Average age at the time of observation was 48.8 years. BMD was measured at the left femoral neck, and the levels of two bone metabolism markers–procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase 5b (TRACP-5b)–were measured from blood samples. Physical performance was measured using grip strength, sit-ups, sit-and-reach, side step, and standing long jump.ResultsMean BMD was 0.784 g/cm2. According to the World Health Organization diagnostic criteria, one subject (4.3%) had osteoporosis, whereas nine subjects (39.1%) had osteopenia. In patients with osteoporosis or osteopenia, P1NP and TRACP-5b levels were high, and BMD loss was because of high metabolic turnover. All calculated standard scores for physical performance were lower in the study cohort than in healthy individuals. There was a positive correlation between BMD and the standard score for grip strength, whereas there were weak positive correlations between BMD and the standard scores for side step and standing long jump.ConclusionsIn female AIS patients who underwent spinal fusion in adolescence, 4.3% and 39.1% had osteoporosis and osteopenia, respectively, ≥27 years after surgery. Exercise performance of these patients was poor compared with the national standards. In these patients, increased physical activity should be encouraged to prevent BMD loss in middle age.

Scoliosis Treatment With Growth-Friendly Spinal Implants (GFSI) Relates to Low Bone Mineral Mass in Children With Spinal Muscular Atrophy

“…McAfee et al and Dalenberg et al demonstrated in their preclinical canine models the negative influence of rigid spinal implants on BMD 31,32 . Long-term follow-ups after 2 to 3 decades after spinal fusion on grounds of idiopathic scoliosis found in up to 50% of the cases of osteopenia and osteoporosis 33,34 . Even though these studies are not directly comparable with GFSI in adolescents with SMA, they still suggest the influence of rigid spinal instrumentation on bone health.…”

Phosphorylated heat shock protein 27 improves the bone formation ability of osteoblasts and bone marrow stem cells from patients with adolescent idiopathic scoliosis

“…Studies have shown that a large number of AIS patients have abnormal bone metabolism 3–7 . Abnormal bone metabolism may lead to a larger curve 8–10 and reduced ability to exercise after surgery in adulthood 11,12 . Currently, an increasing number of studies have confirmed the relationship between abnormal bone metabolism and AIS.…”

“…AIS with abnormal bone metabolism mtay lead to a more serious clinical manifestation, such as a larger curve 8–10 . Two long‐term follow‐up studies showed that approximately half of AIS patients treated with surgery will develop osteopenia or osteoporosis in adulthood, which makes some patients with AIS less able to exercise in adulthood 11,12 . Therefore, bone metabolism has a great influence on the pathogenesis, development, and long‐term prognosis of AIS.…”

Effects of Abdominal Aortic Calcification and Facet Joint Arthritis On Lumbar Bone Mineral Density Using Dual-Energy X-Ray Absorptiometry

“…FJA was introduced as an ordinal scale with values ranging from 0 to 3 according to the grading system. Other factors such as the presence of vertebral fracture, fusion surgery [17],…”