Characterization of Osteopenia/Osteoporosis in Adult Scoliosis. Does bone density affect surgical outcome?

By London Spine

Characterization of Osteopenia/Osteoporosis in Adult Scoliosis. Does bone density affect surgical outcome?

Spine (Phila Pa 1976). 2011 Feb 7;

Authors: Yagi M, Boachie-Adjei O, King AB

Study Design. Retrospective studyObjective. The aim of this study is to validate the prevalence of low bone mineral density (BMD) in female patients with adult scoliosis and to relate that to surgical treatment outcome. Despite reports of the high prevalence of low BMD among female with adolescent idiopathic, this findings has not been substantiated in any comprehensive review of adult scoliosis patients undergoing surgical treatment.Summary of Background Data. It has been suggested that scoliosis may predispose to osteoporosis and that degenerative scoliosis (DS) could falsely elevate spinal BMD measurements with Dual energy X-ray absorptiometry (DXA). The discordance between hip and spine BMD measurement using DXA has also been shown in previous cross sectional study for adult population.Methods. A retrospective review of 176 females treated surgically for scoliosis. BMD of the lumbar spine and femoral neck were determined by DXA. Patients were categorized as follows: concordance (osteoporosis, osteopenia, or normal BMD on both sites), minor discordance (osteoporosis 1 site and osteopenia in the other site), and major discordance (osteoporosis in 1 site and normal the other site). Body mass index (BMI), pre operative cobb angle, fusion ratio and complication were recorded. Statistical analysis included student’s t test, chi-square test, regression coefficient test and simple linear regression. P value was set at p<0.05.Results. The mean age was 51±12 years (26-82 yrs). The mean T-score of the hip was -1.23±1.18 and of the spine was-0.52±1.63. Major discordance in BMD 7 (4%) pts, minor discordance 68 (39%) pts and concordance was 101 (57%) pts. There was moderate correlation between T-score of hip and spine (R = 0.55 p<0.01). T-score of the hip and of the spine showed 10.8% and 10.2% of the patients were osteoporotic. The mean Z-score of the hip and of the spine showed comparable age and sex matched values. No correlation was observed between BMD and cobb angle (R = 0.05 p = 0.464). The fusion rate was 93% and surgical complication rate was 13.6%. No significant correlation was observed between BMD and fusion (p = 0.47) complication (p = 0.80).Conclusion. Comparable bone density exists among adult scoliosis patients with no correlation between BMD and curve magnitude, fusion and complication rates. The difference in BMD of the hip and of spine can not be fully explained in the review. These results will guide in surgical planning, patient select on the treatment options.

PMID: 21304426 [PubMed – as supplied by publisher]