Using Calcium and Vitamin D Supplementation to Control Disease Progression in Adolescent Idiopathic Scoliosis (AIS) with – A Randomised Double-blinded Placebo-controlled Trial
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AbstractIntroduction:
AIS is associated with low bone mass which has been reported to be an independent and significant prognostic factor for curve progression. Vitamin D (Vit-D) and calcium are crucial for bone mineralization. Previous reports indicated AIS subjects had low dietary calcium intakes and low Vit-D levels. This study evaluated if oral calcium and Vit-D supplement could improve low bone mass and prevent curve progression in AIS girls.

Subjects and Methods:
This was a randomised double-blinded placebo-controlled trial. 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 Group1 (N=110, placebo), Group2 (N=110, 600mg calcium + 400IU Vit-D3/day) and Group3 (N=110, 600mg calcium + 800IU Vit-D3/day). At baseline and after completion of 2-year treatment, the following measurements were performed: serum 25(OH)Vit-D by liquid chromatography isotope-dilution electrospray ionization tandem mass spectrometry (LCTMS); areal BMD and BMC of bilateral femoral necks by Dual-Energy X-ray Absorptiometry (DXA); and volumetric BMD, bone geometry and trabecular bone micro-architecture of distal radius by High-resolution Peripheral Quantitative Computed
Tomography (HR-pQCT). Curve progression was defined as increase in Cobb angle ≥6°.

Results:
270 (81.8%) subjects completed the 2-year treatment (91 in Group1 & 2, 88 in Group3). 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 micro-architecture parameters at the end of 2-year treatment showed improvement in bone health with calcium +Vit-D supplement (p<0.05). At the latest follow-up for: (i) those with initial Cobb angle ≤ 40° and (ii) those who were not on brace treatment or never been braced (N=132), 21.7% in Group3 and 24.4% in Group2 had curve progression as compared with 46.7% in Group1 (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).

Discussion and Conclusion:
Daily 600mg calcium +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 calcium and Vit-D supplementation as appropriate.

Funding Source: This study was partially funded by an Investigator Initiated Research grant from Pfizer Inc (IIR Grant No. WI 174540). (ClinicalTrials.gov-Identifier:NCT01103115)
All Author(s) ListE. M. S. Tam, B. H. K. Yip, F. W. P. Yu, G. C. W. Man, W. Y. W. Lee, K. M. Lee, B. K. W. Ng, J. C. Y. Cheng, T. P. Lam
Name of Conference2016 International Combined Meeting of Orthopaedics Research Societies
Start Date of Conference21/09/2016
End Date of Conference25/09/2016
Place of ConferenceXi'an, China
Country/Region of ConferenceChina
Year2016
LanguagesEnglish-United Kingdom

Last updated on 2018-22-01 at 09:16