Determinants of Effective Control of Curve Progression Using Calcium and Vitamin D Supplementation in Adolescent Idiopathic Scoliosis – In-depth Analysis of a Randomized Double-blinded Placebo-controlled Trial
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AbstractPurpose: Adolescent Idiopathic Scoliosis (AIS) is associated with low bone mass. This study aimed at evaluating the therapeutic effect and its determinants of Ca+Vit-D supplementation in improving bone strength and preventing curve progression in AIS.

Methods: This was a randomized double-blinded placebo-controlled trial recruiting AIS girls (11-14 years old, Tanner stage15°. 330 subjects were randomized to Group1 (placebo), Group2 (600mg Calcium+400 IU Vit-D3/day) or Group3 (600mg Calcium+800 IU Vit-D3/day) for 2-year treatment. Investigations at baseline and 24-month included: (1) Finite Element Analysis (FEA) on High-resolution Peripheral Quantitative Computed Tomography at distal radius, (2) serum 25(OH)Vit-D assay and (3) dietary calcium intake. The SRS guideline for scoliosis outcome study was followed for the Latest Follow-up analysis on curve progression defined as increase in Cobb angle≥6°. Chi-square, ANOVA, logistic regression model and ANCOVA were used for statistical analyses. P value<0.05 was considered statistically significant.

Results: 270 (81.8%) subjects completed the study. At 24-month, the increases in serum 25(OH)Vit-D and FEA parameters including stiffness (kN/mm), failure load (N) and apparent modulus (MPa) were significantly greater in the Treatment Group3 than Group1 (Figure1). The Latest Follow-up (N=132) showed that 21·7% in Group3 and 24·4% in Group2 had curve progression as compared with 46·7% in Group1. Within-group logistic regression
analysis showed in Group3, increase in FEA parameters of failure load and apparent modulus were significant protective factors against curve progression (p=0.043 and 0.034 respectively). Using the same logistic regression model, subgroup analysis for baseline serum 25(OH)Vit-D≤50nmol/L (N=103) showed that the adjusted odds ratio for curve progression was 0·242 when Group3 was compared with Group1 (p=0·015), with 16.2% having curve progression in Group3 and 48.6% in Group1 (p=0.003). For those with 25(OH)Vit-D>50nmol/L (N=29), no between-group difference was noted on curve progression. As for baseline dietary calcium intake levels in the combined Treatment Group (2 & 3), 17.6% progressed when baseline dietary calcium intake≤1000mg/day as compared with 53.8% progressed when baseline dietary calcium intake>1000mg/day (p=0.009).

Conclusion: The results of this study provide strong evidences that calcium+Vit-D supplementation can improve bone strength and its therapeutic effect of preventing curve progression in AIS is correlated with increase in FEA parameters in the Treatment Group, low baseline 25(OH)Vit-D level and low baseline dietary calcium intake.

Significance: This study provides the evidence-based justification for a new therapeutic approach for AIS to prevent curve from progression especially for those with low 25(OH)Vit-D or low dietary calcium intake levels.
All Author(s) ListTsz Ping Lam, Benjamin HK Yip, Ka-Yee Cheuk, Elisa MS Tam, Gene CW Man, Wayne YW Lee, Simon KM Lee, Fiona WP Yu, Feng Zhu, Alec Lik Hang Hung, Bobby Ng, Jack CY Cheng
Name of Conference2017 Combined European Paediatric Orthopaedic Society (EPOS)/ Pediatric Orthopaedics Society of North America (POSNA) Annual Meeting (EPOSNA)
Start Date of Conference03/05/2017
End Date of Conference06/05/2017
Place of ConferenceBarcelona, Spain
Country/Region of ConferenceSpain
LanguagesEnglish-United Kingdom

Last updated on 2018-18-01 at 08:25