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Bone mineral density in children and young adults with idiopathic scoliosis: a systematic review and meta-analysis

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Abstract

Purpose

Osteoporosis is a risk factor for idiopathic scoliosis (IS) progression, but it is still unclear whether IS patients have bone mineral density (BMD) loss and a higher risk of osteoporosis than asymptomatic people. This systematic review aims to explore the differences in BMD and prevalence of osteoporosis between the IS group and the control group.

Methods

We searched 5 health science-related databases. Studies that were published up to February 2022 and written in English and Chinese languages were included. The primary outcome measures consisted of BMD z score, the prevalence of osteoporosis and osteopenia, and areal and volumetric BMD. Bone morphometry, trabecular microarchitecture, and quantitative ultrasound measures were included in the secondary outcome measures. The odds ratio (OR) and the weighted mean difference (WMD) with a 95% confidence interval (CI) were used to pool the data.

Results

A total of 32 case–control studies were included. The pooled analysis revealed significant differences between the IS group and the control group in BMD z score (WMD −1.191; 95% CI  − 1.651 to −0.732, p  <  0.001). Subgroup analysis showed significance in both female (WMD −1.031; 95% CI −1.496 to −0.566, p  <  0.001) and male participants (WMD −1.516; 95% CI −2.401 to −0.632, p  =  0.001). The prevalence of osteoporosis and osteopenia in the group with IS was significantly higher than in the control group (OR  =  6.813, 95% CI 2.815–16.489, p  <  0.001; OR 1.879; 95% CI 1.548–2.281, p  <  0.000). BMD measures by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography showed a significant decrease in the IS group (all p  <  0.05), but no significant difference was found in the speed of sound measured by quantitative ultrasound between the two groups (p > 0.05).

Conclusion

Both the male and female IS patients had a generalized lower BMD and an increased prevalence of osteopenia and osteoporosis than the control group. Future research should focus on the validity of quantitative ultrasound in BMD screening. To control the risk of progression in IS patients, regular BMD scans and targeted intervention are necessary for IS patients during clinical practice.

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Abbreviations

IS:

Idiopathic scoliosis

BMD:

Bone mineral density

WOS:

Web of Science

CINAHL:

Cumulative Index of Nursing and Allied Health Literature

aBMD:

Areal bone mineral density

DEXA:

Dual-energy X-ray absorptiometry

vBMD:

Volume bone mineral density

pQCT:

Peripheral quantitative computed tomography

SOS:

Speed of sound

BUA:

Broadband ultrasonic attenuation

SI:

Stiffness index

NOS:

Newcastle–Ottawa scale

GRADE:

Grading of recommendation assessment, development, and evaluation

OR:

Odds ratio

CI:

Confidence interval

WMD:

Weighted mean difference

BMI:

Body mass index

ROI:

Region of interest

LSBMD:

Lumbar spine BMD

FNBMD:

Femoral neck BMD

BV/TV:

Trabecular bone volume to tissue volume ratio

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Funding

This work was supported by the General Program of National Natural Science Foundation of China (81972030), Clinical Research Plan of SHDC (SHDC2020CR3041B), and Action Plan for Sustainable Development of Science and Technology Innovation in Chongming District, Shanghai (CKY2021-50).

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Author notes

  1. Yuqi Yang, Xiaoli Han and Zhengquan Chen contributed equally to this study.

Authors and Affiliations

  1. College of Global Public Health, New York University, New York, USA

    Yuqi Yang

  2. Centers for Disease Control and Prevention of Chongming, Shanghai, China

    Xiaoli Han

  3. Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

    Zhengquan Chen, Xin Li, Xiaoqing Zhu, Zefan Huang, Xuan Zhou & Qing Du

  4. Chongming Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China

    Haiyan Yuan & Qing Du

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Contributions

The study’s concept and design were contributed to by QD and XZ. Material preparation, data collection and analysis were performed by YY, XH, ZC and XL. YY and HY assessed the bias in articles, and disagreements were settled by QD. All the authors contributed to the draft of the manuscript.

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Correspondence to Xuan Zhou or Qing Du.

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Yang, Y., Han, X., Chen, Z. et al. Bone mineral density in children and young adults with idiopathic scoliosis: a systematic review and meta-analysis. Eur Spine J 32, 149–166 (2023). https://doi.org/10.1007/s00586-022-07463-w

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