Preventing Curve Progression in Adolescent Idiopathic Scoliosis (AIS) with Calcium and Vitamin D Supplementation – A Randomised Double-blinded Placebo-controlled Trial
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摘要Summary
AIS is associated with osteopenia. Previous reports indicated AIS subjects had low dietary calcium (Ca) intakes and low Vit-D levels. This clinical trial on immature AIS girls with baseline areal- BMD Z-score<0 and Cobb angle≥15° indicates daily [600mg Ca + 400/800 IU Vit-D3] can improve low bone mass and prevent curve progression in AIS after adjusted for baseline maturity, baseline curve severity and bracing history.

Hypothesis
[Ca + Vit-D] supplement can improve low bone mass and prevent curve progression in AIS. Design Randomised double-blinded placebo-controlled trial

Introduction
AIS is associated with osteopenia which has been reported to be an independent and significant prognostic factor for curve progression. This study evaluated if oral [Ca + Vit-D] supplement could improve low bone mass and prevent curve progression in AIS girls.

Methods
330 AIS girls (mean age: 12.9±0.9 years) with femoral neck areal- BMD Z-score<0 and radiological Cobb angle≥15° were randomized to Group 1 (N=110, placebo), Group 2 (N=110, [600mg Ca + 400IU Vit-D3]/day) and Group 3 (N=110, [600mg Ca + 800IU Vit-D3]/day). At baseline and at the end of 2-year treatment, serum 25(OH)Vit-D, Dual-Energy X-ray Absorptiometry (DXA) of femoral necks and High-resolution Peripheral Quantitative Computed Tomography (HR-pQCT) at distal radius were performed. Curve progression was defined as increase in Cobb angle≥6°.

Results
270 (81.8%) subjects completed the 2-year treatment (91 in Group 1 & 2, 88 in Group 3). At baseline, mean serum 25(OH) Vit-D was 41.2±14.7 nmol/L and mean Cobb angle was 25.9±8.4°. Mean increase in serum 25(OH)Vit-D at 2-year were 6.3±15.3, 20.4±19.6 and 28.0±23.3 nmol/L for Group1, 2 and 3 respectively (p<0.001). Changes in areal-BMD, Average & Trabecular volumetric-BMD and Trabecular HR-pQCT parameters at the end of 2-year treatment showed improvement in bone health with [Ca + Vit-D] supplement (p<0.05). At the latest follow-up for those:(i)with initial Cobb angle≤40° and (ii)with brace weaned off or never been braced (N=132), 21.7% in Group 3 and 24.4% in Group 2 had curve progression as compared with 46.7% in Group 1 (p<0.05). For those with baseline serum 25(OH)Vit-D≤50nmol/L (N=103), 16.2% had curve progression in Group 3 as compared with 48.6% in Group 1 (p=0.003).

Conclusion
Daily [600mg Ca + 400/800 IU Vit-D3] can improve low bone mass and prevent curve progression in AIS. Vit-D status and bone density and quality should be assessed for AIS subjects and be followed with [Ca + Vit-D] supplementation as appropriate.
著者T. P. Lam, B. H. K. Yip, E. M. S. Tam, G. C. W. Man, W. Y. W. Lee, K. M. Lee, F. W. P. Yu, Y. Qiu, B. K. W. Ng, J. C. Y. Cheng
會議名稱51st Annual Meeting of Scoliosis Research Society (SRS)
會議開始日21.09.2016
會議完結日24.09.2016
會議地點Prague, Czech Republic
會議國家/地區捷克共和國
出版年份2016
頁次179 - 180
語言英式英語

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