Scoliosis in osteogenesis imperfecta: identifying the genetic and non-genetic factors affecting severity and progression from longitudinal data of 290 patients

Orphanet Journal of Rare Diseases

Research

Yunzhi Lin¹  Daniel Li-Liang Lin¹  Jingwei Wu¹  Jianbin Wu¹  Hiu Tung Shek¹  Yapeng Zhou¹  Zeluan Li¹  Feng Zhu²  Kenneth Man-Chee Cheung²  Zhijia Tan²  Michael Kai-Tsun To²  Yong Hu³  Danny Chan⁴  Peikai Chen⁵ 

[1] Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), 518053, Shenzhen, Guangdong, China;Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), 518053, Shenzhen, Guangdong, China;Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong;Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), 518053, Shenzhen, Guangdong, China;Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong;The Artificial Intelligence and Big Data (AIBD) Lab, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, Guangdong, China;Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), 518053, Shenzhen, Guangdong, China;School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong;Department of Orthopedics and Traumatology, The University of Hong Kong – Shenzhen Hospital (HKU-SZH), 518053, Shenzhen, Guangdong, China;School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong;The Artificial Intelligence and Big Data (AIBD) Lab, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, Guangdong, China;

关键词: Scoliosis;    Osteogenesis imperfecta;    Genetics;    Progression rate;    Logistic regression;    Multivariate regression;   

DOI  :  10.1186/s13023-023-02906-z

 received in 2023-04-14, accepted in 2023-09-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundScoliosis is widely prevalent among osteogenesis imperfecta (OI) patients, and is progressive with age. However, factors affecting scoliosis in OI are not well known.MethodsWe retrospectively retrieved longitudinal radiographic and clinical records of consecutive OI patients seeking treatments at our hospital from 2014 to 2022, graded their pre-operative spinal conditions into four outcome groups, estimated their progression rates, and descriptively and inferentially analyzed the genetic and non-genetic factors that may affect the outcomes and progression rates.ResultsIn all, 290 OI patients met the inclusion criteria, where 221 had genetic records. Of these 221, about 2/3 had mutations in COL1A1 or COL1A2, followed by mutations in WNT1 (9.0%), IFITM5 (9.0%) and other OI risk genes. With an average age of 12.0 years (interquartile range [IQR] 6.9–16.1), 70.7% of the cohort had scoliosis (Cobb angle > 10°), including 106 (36.5%) mild (10°–25°), 40 (13.8%) moderate (25°–50°), and 59 (20.3%) severe (> 50°) scoliosis patients. Patients with either COL1A1 and COL1A2 were strongly biased toward having mild or no scoliosis, whereas patients with mutations in IFITM5, WNT1 and other recessive genes were more evenly distributed among the four outcome grades. Lower-limb discrepancy, bone mineral density (BMD) and age of first drug used were all significantly correlated with severity outcomes. Using multivariate logistic regression, we estimated that each year older adds an odds ratio of 1.13 (95% confidence interval [CI] 1.07–1.2) in progression into advanced stages of scoliosis. We estimated a cohort-wide progression rate of 2.7 degrees per year (95% CI 2.4–3.0). Early-onset patients experienced fast progressions during both infantile and adolescent stages. Twenty-five of the 59 (42.8%) patients with severe scoliosis underwent spinal surgeries, enjoying an average Cobb angle reduction of 33° (IQR 23–40) postoperatively.ConclusionThe severity and progression of scoliosis in osteogenesis imperfecta were affected by genetic factors including genotypes and mutation types, and non-genetic factors including age and BMD. As compared with COL1A1, mutations in COL1A2 were less damaging while those on IFITM5 and other recessive genes conferred damaging effects. Progression rates were the fastest in the adolescent adult age-group.

【 授权许可】

CC BY   
© Institut National de la Santé et de la Recherche Médicale (INSERM) 2023

【 图 表 】

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