Transient decrease in cortical bone density and mechanical strength with elevated bone turnover markers at peripubertal peak height velocity: a cross-sectional and longitudinal cohort study of 396 girls with adolescent idiopathic scoliosis
Invited conference paper presented and published in conference proceedings
CUHK Authors
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AbstractPurpose: Keeping in mind that low bone mass in Adolescent Idiopathic Scoliosis (AIS) has been reported to be a
significant prognostic factor for AIS progression, and that AIS progression typically occurs at time of peri-pubertal
peak height velocity (PHV), we carried out the current study aiming to investigate bone qualities and bone turnover
markers (BTMs) at various bone maturity stages across peripubertal PHV in girls with AIS.
Methods: 369 girls who were 10-14 years old and were diagnosed with AIS in two separate cohorts were studied.
Cohort-A included 179 subjects. In the first clinical visit, body height was measured. Skeletal maturity was assessed
using the validated Thumb Ossification Composite Index (TOCI, 8 stages, i.e. TOCI-1 to TOCI-8) in which TOCI-4
and TOCI-5 have been reported to correlate well with the timing of peri-pubertal PHV. Bone qualities and bone
mechanical strength were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT)
and finite element analysis (FEA), respectively. Physical activity index and dietary calcium intake were assessed by
validated quantitative questionnaires. Each subject had a follow-up visit 6 months afterwards when body height was
measured. Cohort-B included 217 subjects. Skeletal maturity was assessed using the same method as that for
Cohort-A subjects. BTMs were evaluated using Roche Elecsys.
Results: Subjects at TOCI-4 had numerically the highest body height velocity (0.71±0.24 cm/month) among all
TOCI stages. Cortical volumetric bone mineral density (vBMD), cortical thickness and apparent modulus were
significantly lower in subjects at TOCI-4 than those at TOCI-1-3 and those at TOCI-8 (Figure 1). Subjects at TOCI-
4 had significantly higher levels of circulating bone-specific alkaline phosphatase (bALP), C-telopeptide of type 1
collagen (CTX), N-terminal propeptide of type I procollagen (P1NP) and phosphate than those at TOCI-8.
Conclusion: Bone qualities, bone mechanical strength, and BTMs at early puberty correlated with peri-pubertal
skeletal maturity stages in girls with AIS. The subjects had decreased cortical bone density and bone mechanical
strength with associated elevation of BTMs at peri-pubertal PHV.
Significance: TOCI classification system was found to be useful in accurately assessing the skeletal maturity stages
at the peri-pubertal period in AIS. Coupling of peri-pubertal PHV with decreased cortical and FEA parameters could
provide the link to the previously reported observation that low BMD could contribute as one of the prognostic
factors for curve progression that mostly occurs during peri-pubertal PHV in AIS. This study was supported by GRF
(14130216, 14174517, 14163517 and 14120818), and HMRF (06170546) of Hong Kong.
significant prognostic factor for AIS progression, and that AIS progression typically occurs at time of peri-pubertal
peak height velocity (PHV), we carried out the current study aiming to investigate bone qualities and bone turnover
markers (BTMs) at various bone maturity stages across peripubertal PHV in girls with AIS.
Methods: 369 girls who were 10-14 years old and were diagnosed with AIS in two separate cohorts were studied.
Cohort-A included 179 subjects. In the first clinical visit, body height was measured. Skeletal maturity was assessed
using the validated Thumb Ossification Composite Index (TOCI, 8 stages, i.e. TOCI-1 to TOCI-8) in which TOCI-4
and TOCI-5 have been reported to correlate well with the timing of peri-pubertal PHV. Bone qualities and bone
mechanical strength were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT)
and finite element analysis (FEA), respectively. Physical activity index and dietary calcium intake were assessed by
validated quantitative questionnaires. Each subject had a follow-up visit 6 months afterwards when body height was
measured. Cohort-B included 217 subjects. Skeletal maturity was assessed using the same method as that for
Cohort-A subjects. BTMs were evaluated using Roche Elecsys.
Results: Subjects at TOCI-4 had numerically the highest body height velocity (0.71±0.24 cm/month) among all
TOCI stages. Cortical volumetric bone mineral density (vBMD), cortical thickness and apparent modulus were
significantly lower in subjects at TOCI-4 than those at TOCI-1-3 and those at TOCI-8 (Figure 1). Subjects at TOCI-
4 had significantly higher levels of circulating bone-specific alkaline phosphatase (bALP), C-telopeptide of type 1
collagen (CTX), N-terminal propeptide of type I procollagen (P1NP) and phosphate than those at TOCI-8.
Conclusion: Bone qualities, bone mechanical strength, and BTMs at early puberty correlated with peri-pubertal
skeletal maturity stages in girls with AIS. The subjects had decreased cortical bone density and bone mechanical
strength with associated elevation of BTMs at peri-pubertal PHV.
Significance: TOCI classification system was found to be useful in accurately assessing the skeletal maturity stages
at the peri-pubertal period in AIS. Coupling of peri-pubertal PHV with decreased cortical and FEA parameters could
provide the link to the previously reported observation that low BMD could contribute as one of the prognostic
factors for curve progression that mostly occurs during peri-pubertal PHV in AIS. This study was supported by GRF
(14130216, 14174517, 14163517 and 14120818), and HMRF (06170546) of Hong Kong.
All Author(s) ListKenneth Yang, Wayne Lee, Alex Hung, Jack Cheng, TP Lam
Name of Conference2022 Annual Meeting of Pediatric Orthopaedics Society of North America (POSNA)
Start Date of Conference11/05/2022
End Date of Conference14/05/2022
Place of ConferenceVancouver, BC, Canada
Country/Region of ConferenceCanada
Year2022
LanguagesEnglish-United Kingdom
