Does bracing affect bone health in women with adolescent idiopathic scoliosis?

Scoliosis

Bareket Falk¹  Philip M Wilson²  Panagiota Klentrou¹  Matthew Greenway³  W Alan Rigby⁴  Kimberly Kish⁴  Nasreen Akseer⁴ 

[1] Centre for Bone and Muscle Health, Faculty of Applied Health Sciences, Brock University, 500 Glenridge Avenue, St. Catharines, ON, Canada;Behavioral Health Sciences Research Lab, Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada;Michael G. DeGroote School of Medicine, Niagara Regional Campus, McMaster University, 500 Glenridge Avenue, St. Catharines, ON, Canada;Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, 500 Glenridge Avenue, St. Catharines, ON, Canada

关键词: Physical activity;    Nutrition;    Maturation;    Growth;    Female;    Exercise;    DXA;    Brace;    Bone;    Adulthood;    Adolescence;   

Others  :  1137159
DOI  :  10.1186/s13013-015-0031-1

 received in 2014-12-15, accepted in 2015-02-03,  发布年份 2015

【 摘 要 】

Purpose

Adolescent idiopathic scoliosis (AIS) is often associated with low bone mineral content and density (BMC, BMD). Bracing, used to manage spine curvature, may interfere with the growth-related BMC accrual, resulting in reduced bone strength into adulthood. The purpose of this study was to assess the effects of brace treatment on BMC in adult women, diagnosed with AIS and braced in early adolescence.

Methods

Participants included women with AIS who: (i) underwent brace treatment (AIS-B, n = 15, 25.6 ± 5.8 yrs), (ii) underwent no treatment (AIS, n = 15, 24.0 ± 4.0 yrs), and (iii) a healthy comparison group (CON, n = 19, 23.5 ± 3.8 yrs). BMC and body composition were assessed using dual-energy X-ray absorptiometry. Differences between groups were examined using a oneway ANOVA or ANCOVA, as appropriate.

Results

AIS-B underwent brace treatment 27.9 ± 21.6 months, for 18.0 ± 5.4 h/d. Femoral neck BMC was lower (p = 0.06) in AIS-B (4.54 ± 0.10 g) compared with AIS (4.89 ± 0.61 g) and CON (5.07 ± 0.58 g). Controlling for lean body mass, calcium and vitamin D daily intake, and strenuous physical activity, femoral neck BMC was statistically different (p = 0.02) between groups. A similar pattern was observed at other lower extremity sites (p < 0.05), but not in the spine or upper extremities. BMC and BMD did not correlate with duration of brace treatment, duration of daily brace wear, or overall physical activity.

Conclusion

Young women with AIS, especially those who were treated with a brace, have significantly lower BMC in their lower limbs compared to women without AIS. However, the lack of a relationship between brace treatment duration during adolescence and BMC during young adulthood, suggests that the brace treatment is not the likely mechanism of the low BMC.

【 授权许可】

   
2015 Akseer et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]James JI: Idiopathic scoliosis; the prognosis, diagnosis, and operative indications related to curve patterns and the age at onset. J Bone Joint Surg Br 1954, 36-B:36-49.
• [2]Roach JW: Adolescent idiopathic scoliosis. Orthop Clin North Am 1999, 30:353-65.
• [3]Maruyama T, Grivas TB, Kaspiris A: Effectiveness and outcomes of brace treatment: a systematic review. Physiother Theory Pract 2011, 27:26-42.
• [4]Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, et al.: 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012, 7:3. BioMed Central Full Text
• [5]Weinstein SL, Dolan LA, Wright JG, Dobbs MB: Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013, 369:1512-21.
• [6]Danielsson AJ, Romberg K, Nachemson AL: Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case–control study. Spine (Phila Pa 1976) 2006, 31:275-83.
• [7]Rogala EJ, Drummond DS, Gurr J: Scoliosis: incidence and natural history: a prospective epidemiological study. J Bone Joint Surg Am 1978, 60:173-6.
• [8]Climent JM, Sanchez J: Impact of the type of brace on the quality of life of adolescents with spine deformities. Spine (Phila Pa 1976) 1999, 24:1903-8.
• [9]Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL: Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J 2001, 10:278-88.
• [10]Matkovic V, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, et al.: Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J Clin Invest 1994, 93:799-808.
• [11]MacKelvie KJ, Khan KM, McKay HA: Is there a critical period for bone response to weight-bearing exercise in children and adolescents? a systematic review. Br J Sports Med 2002, 36:250-7. discussion 257
• [12]Boreham CA, McKay HA: Physical activity in childhood and bone health. Br J Sports Med 2011, 45:877-9.
• [13]Hind K, Burrows M: Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone 2007, 40:14-27.
• [14]Janz KF, Letuchy EM, Eichenberger Gilmore JM, Burns TL, Torner JC, Willing MC, et al.: Early physical activity provides sustained bone health benefits later in childhood. Med Sci Sports Exerc 2010, 42:1072-8.
• [15]Lonstein JE: Scoliosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006, 443:248-59.
• [16]Cheng JC, Qin L, Cheung CS, Sher AH, Lee KM, Ng SW, et al.: Generalized low areal and volumetric bone mineral density in adolescent idiopathic scoliosis. J Bone Miner Res 2000, 15:1587-95.
• [17]Cheng JC, Tang SP, Guo X, Chan CW, Qin L: Osteopenia in adolescent idiopathic scoliosis: a histomorphometric study. Spine (Phila Pa 1976) 2001, 26:E19-23.
• [18]Lee WT, Cheung CS, Tse YK, Guo X, Qin L, Ho SC, et al.: Generalized low bone mass of girls with adolescent idiopathic scoliosis is related to inadequate calcium intake and weight bearing physical activity in peripubertal period. Osteoporos Int 2005, 16:1024-35.
• [19]Park WW, Suh KT, Kim JI, Kim SJ, Lee JS: Decreased osteogenic differentiation of mesenchymal stem cells and reduced bone mineral density in patients with adolescent idiopathic scoliosis. Eur Spine J 2009, 18:1920-6.
• [20]Sadat-Ali M, Al-Othman A, Bubshait D, Al-Dakheel D: Does scoliosis causes low bone mass? A comparative study between siblings. Eur Spine J 2008, 17:944-7.
• [21]Szalay EA, Bosch P, Schwend RM, Buggie B, Tandberg D, Sherman F: Adolescents with idiopathic scoliosis are not osteoporotic. Spine (Phila Pa 1976) 2008, 33:802-6.
• [22]Thomas KA, Cook SD, Skalley TC, Renshaw SV, Makuch RS, Gross M, et al.: Lumbar spine and femoral neck bone mineral density in idiopathic scoliosis: a follow-up study. J Pediatr Orthop 1992, 12:235-40.
• [23]Zhu F, Qiu Y, Yeung HY, Lee KM, Cheng CY: Trabecular bone micro-architecture and bone mineral density in adolescent idiopathic and congenital scoliosis. Orthopaedic surgery 2009, 1:78-83.
• [24]Snyder AC, Woulfe T, Welsh R, Foster C: A simplified approach to estimating the maximal lactate steady state. Int J Sports Med 1994, 15:27-31.
• [25]Snyder BD, Katz DA, Myers ER, Breitenbach MA, Emans JB: Bone density accumulation is not affected by brace treatment of idiopathic scoliosis in adolescent girls. J Pediatr Orthop 2005, 25:423-8.
• [26]Snyder BD, Zaltz I, Breitenbach MA, Kido TH, Myers ER, Emans JB: Does bracing affect bone density in adolescent scoliosis? Spine (Phila Pa 1976) 1995, 20:1554-60.
• [27]Sun X, Qiu Y, Zhu Z: The accumulation of bone mineral content and density in idiopathic scoliotic adolescents treated with bracing. Stud Health Technol Inform 2006, 123:233-8.
• [28]Qiu Y, Sun X, Cheng JC, Zhu F, Li W, Zhu Z, et al.: Bone mineral accrual in osteopenic and non-osteopenic girls with idiopathic scoliosis during bracing treatment. Spine (Phila Pa 1976) 2008, 33:1682-9.
• [29]Courtois I, Collet P, Mouilleseaux B, Alexandre C: Bone mineral density at the femur and lumbar spine in a population of young women treated for scoliosis in adolescence. Rev Rhum Engl Ed 1999, 66:705-10.
• [30]Kannus P, Haapasalo H, Sievanen H, Oja P, Vuori I: The site-specific effects of long-term unilateral activity on bone mineral density and content. Bone 1994, 15:279-84.
• [31]Greger JL, Etnyre GM: Validity of 24-hour dietary recalls by adolescent females. Am J Public Health 1978, 68:70-2.
• [32]Sun Y, Roth DL, Ritchie CS, Burgio KL, Locher JL: Reliability and predictive validity of energy intake measures from the 24-hour dietary recalls of homebound older adults. J Am Diet Assoc 2010, 110:773-8.
• [33]Friedenreich CM, Courneya KS, Bryant HE: The lifetime total physical activity questionnaire: development and reliability. Med Sci Sports Exerc 1998, 30:266-74.
• [34]Godin G, Shephard RJ: A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985, 10:141-6.
• [35]Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS: A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 1993, 25:81-91.
• [36]Tabachnick BG, Fidel LS: Using Multivariate Statistics. Pearson Education, Boston; 2013.
• [37]Bailey DA: The Saskatchewan pediatric bone mineral accrual study: bone mineral acquisition during the growing years. Int J Sports Med 1997, 18(Suppl 3):S191-4.
• [38]Bailey DA, Faulkner RA, McKay HA: Growth, physical activity and bone mineral acquisition. In Exercise and Sports Science Reviews, vol. 24. Edited by Holloszy JO. Williams & Wilkins, Baltimore; 1996:233-66.
• [39]Slemenda CW, Miller JZ, Hui SL, Reister TK, Johnston CC Jr: Role of physical activity in the development of skeletal mass in children. J Bone Miner Res 1991, 6:1227-33.
• [40]Slemenda CW, Reister TK, Hui SL, Miller JZ, Christian JC, Johnston CC Jr: Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 1994, 125:201-7.
• [41]Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD: Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res 1997, 12:1453-62.
• [42]Courteix D, Lespessailles E, Peres SL, Obert P, Germain P, Benhamou CL: Effect of physical training on bone mineral density in prepubertal girls: a comparative study between impact-loading and non-impact-loading sports. Osteoporos Int 1998, 8:152-8.
• [43]Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA: A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 1999, 14:1672-9.
• [44]Fuchs RK, Snow CM: Gains in hip bone mass from high-impact training are maintained: a randomized controlled trial in children. J Pediatr 2002, 141:357-62.
• [45]Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR: American College of Sports M. American college of sports medicine position stand: physical activity and bone health. Med Sci Sports Exerc 2004, 36:1985-96.
• [46]Cashman KD: Diet, nutrition, and bone health. J Nutr 2007, 137:2507S-12.
• [47]Francis RM, Anderson FH, Patel S, Sahota O, van Staa TP: Calcium and vitamin D in the prevention of osteoporotic fractures. QJM 2006, 99:355-63.
• [48]Whiting SJ, Vatanparast H, Baxter-Jones A, Faulkner RA, Mirwald R, Bailey DA: Factors that affect bone mineral accrual in the adolescent growth spurt. J Nutr 2004, 134:696S-700.
• [49]Bailey DA, Martin AD, McKay HA, Whiting S, Mirwald R: Calcium accretion in girls and boys during puberty: a longitudinal analysis. J Bone Miner Res 2000, 15:2245-50.
• [50]Hinriksdottir G, Arngrimsson SA, Misic MM, Evans EM: Lean soft tissue contributes more to bone health than fat mass independent of physical activity in women across the lifespan. Maturitas 2013, 74:264-9.
• [51]Cheng JC, Sher HL, Guo X, Hung VW, Cheung AY: The effect of vertebral rotation of the lumbar spine on dual energy X-ray absorptiometry measurements: observational study. Hong Kong Med J 2001, 7:241-5.
• [52]Girardi FP, Parvataneni HK, Sandhu HS, Cammisa FP Jr, Grewal H, Schneider R, et al.: Correlation between vertebral body rotation and two-dimensional vertebral bone density measurement. Osteoporos Int 2001, 12:738-40.
• [53]Perilli E, Briggs AM, Kantor S, Codrington J, Wark JD, Parkinson IH, et al.: Failure strength of human vertebrae: prediction using bone mineral density measured by DXA and bone volume by micro-CT. Bone 2012, 50:1416-25.
• [54]Falk B, Rigby WA, Akseer N: Adolescent idiopathic scoliosis: the possible harm of bracing and the likely benefit of exercise. Spine J 2014, 15:209-10.
• [55]Frost HM: Bone “mass” and the “mechanostat”: a proposal. Anat Rec 1987, 219:1-9.
• [56]Ruff C, Holt B, Trinkaus E: Who’s afraid of the big bad Wolff?: “Wolff’s law” and bone functional adaptation. Am J Phys Anthropol 2006, 129:484-98.
• [57]Skerry TM: One mechanostat or many? Modifications of the site-specific response of bone to mechanical loading by nature and nurture. J Musculoskelet Neuronal Interact 2006, 6:122-7.
• [58]Martelli S, Kersh ME, Schache AG, Pandy MG: Strain energy in the femoral neck during exercise. J Biomech 2014, 47:1784-91.
• [59]Fehling PC, Alekel L, Clasey J, Rector A, Stillman RJ: A comparison of bone mineral densities among female athletes in impact loading and active loading sports. Bone 1995, 17:205-10.
• [60]Johannsen N, Binkley T, Englert V, Neiderauer G, Specker B: Bone response to jumping is site-specific in children: a randomized trial. Bone 2003, 33:533-9.
• [61]Green BN, Johnson C, Moreau W: Is physical activity contraindicated for individuals with scoliosis? A systematic literature review. J Chiropr Med 2009, 8:25-37.
• [62]Bettany-Saltikov J, Parent E, Romano M, Villagrasa M, Negrini S: Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med 2014, 50:111-21.