Can Volumetric Bone Mineral Density Predict Risk of Surgery in Newly Diagnosed Girls with Adolescent Idiopathic Scoliosis?
Invited conference paper presented and published in conference proceedings


摘要Introduction: Besides osteopenia as one of the prognostic factors of curve progression, poor bone quality including abnormal trabecular microarchitecture, cortical geometry, and bone strength measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) was also found in adolescent idiopathic scoliosis (AIS). This study aimed to explore if bone quality measured by HR-pQCT at initial consultation can predict curve progression to the surgical threshold in AIS.

Methods: Ninety newly diagnosed AIS girls (mean [± standard deviation] age, 13.0 ± 0.8 years) with Cobb’s angle of ≥10° but ≤40° were recruited and followed up clinically and radiologically until skeletal maturity (age ≥15.5 years and ≥2 postmenarchal years) with or without treatment. Non-dominant distal radius was measured by HR-pQCT at first visit. The study outcome was reaching surgical threshold, i.e. Cobb’s angle of ≥45° or had undergone surgery. Classification and Regression Tree analysis (CART) was used to identify the optimal cut-off points of HR-pQCT parameters and the risk classification ability was further assessed by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: At last follow-up, 7 patients had curve progression to the surgical threshold while 83 remained stable. The HRpQCT had significant risk prediction ability with cut-off threshold of cortical volumetric bone mineral density (Dcort)
being <570 mg HA/cm3 for patients with initial Cobb’s angle of ≥24°, reaching 42.9% sensitivity, 100% specificity, 100% PPV, and 95.4% NPV.

Conclusion: Patients with AIS first presented with lower Dcort had significantly higher risk of curve progression to the surgical threshold, thus providing important support to the link of abnormal bone quality to the aetiopathogenesis, prognostication, and potential therapeutic implication in AIS.
著者F. W. P. Yu, B. H. K. Yip, Z. W. Wang, V. W. Y. Hung, T. P. Lam and J. C. Y. Cheng
會議名稱The 36th Annual Congress of the Hong Kong Orthopaedic Association (HKOA)
會議地點Hong Kong

上次更新時間 2018-22-01 於 09:16