The Role of Vitamin D in the Pathogenesis of Adolescent Idiopathic Scoliosis

Gut Microbiota Alterations in Adolescent Idiopathic Scoliosis Are Associated with Aberrant Bone Homeostasis

OBJECTIVE

Low bone mineral density is the major prognostic factor for adolescent idiopathic scoliosis (AIS), but the underlying mechanisms remain unclear. Accumulating evidence suggests that gut microbiota (GM) have the potential to affect bone development, and the GM signatures are altered in AIS patients. However, the effect of GM alterations on aberrant bone homeostasis in AIS remains unclear. This study aims to investigate the GM profile in AIS patients with different bone mineral density (BMD) and explore the association between GM, osteopenia, and aberrant bone turnover.

METHODS

A total of 126 patients with AIS who received surgical treatment were retrospectively included in this study. We analyzed the composition of the GM by 16S rRNA sequencing and BMD by dual X-ray absorptiometry. Based on the BMD of the femur neck, the patients were divided into the osteopenia group (OPN) if the Z score < -1, and the normal (NOR) group if the Z score ≥ -1 SD compared to the healthy control. For the 16S rRNA sequencing, the raw reads were filtered to remove low-quality reads, and operational taxonomic units were identified with the Uparse program. Weighted UniFrac distance matrix for the beta-diversity metrics and principal coordinate analysis (PCoA) was performed, and the statistical comparisons were made with permutational multivariate analysis of variance (PERMANOVA) and analysis of similarity (ANONISM). Linear discriminant analysis effect size (LEfSe) was used to identify the enriched species in two groups. The "Random forest" was applied to determine the optimal biomarker for OPN according to the mean decrease in Gini value. The metabolic function was predicted by the Tax4Fun analysis. The Pearson correlation coefficient was used to evaluate the associations between GM species, bone turnover markers, and BMD.

RESULTS

The serum β-CTX was increased in the OPN group (n = 67) compared to the NOR group (n = 59). Patients in OPN groups showed significantly decreased α diversity indicated by the Shannon index. Principal coordinate analysis (PCoA) analysis showed significant clustering of GM between OPN and NOR groups. At genus level, the Escherichia-Shigella and Faecalibacterium were significantly enriched in the OPN group compared to that in the NOR group (p < 0.05), whereas the abundance of Prevotella was significantly decreased (p = 0.0012). The relative abundance of Megamonas and Prevotella was positively correlated with the femur BMD. The abundance of Escherichia-Shigella was negatively correlated with femur BMD and positively correlated with serum β-CTX levels. Functional analysis revealed significant differences in starch and sucrose metabolism, pyruvate and cysteine, and methionine metabolism between NOR and OPN groups.

CONCLUSION

The alterations of GM in AIS patients are correlated with osteopenia. The association between enriched species, BMD, and bone turnover markers provides novel diagnostic and therapeutic targets for the clinical management of AIS.

Differences in Pubertal Curve Progression among Females with Adolescent Idiopathic Scoliosis Using Pregnenolone Therapy: A Retrospective Case-Controlled Series

Background: Differences in hormone metabolism have been observed in children with adolescent idiopathic scoliosis. These differences have been offered as underlying reasons for rapid curve progression during puberty. This study retrospectively compared two groups of females with a history of adolescent idiopathic scoliosis. They were seen for initial presentation prior to menarche, or within 2 months after menarche, and they were followed up 1 year after first menarche. Methods: All patients in both groups underwent baseline salivary hormone testing to identify any hormone imbalances. The control group was composed of females with curves between 10 and 25 degrees and maintained an observation-only management strategy. The treatment group showed baseline curve measurements ranging from 10 to 23 degrees, and additionally took pregnenolone daily for 12 months. Results: At one-year follow-up, the treatment group showed curve measurements ranging from 13 to 24 degrees, while the control group ranged from 16 to 29 degrees (p < 0.05). Conclusions: The study showed that adolescent females taking pregnenolone daily for low progesterone had reduced scoliosis curve progression over 1 year compared to controls.

Interrogating Causal Effects of Body Composition and Puberty-Related Risk Factors on Adolescent Idiopathic Scoliosis: A Two-Sample Mendelian Randomization Study

Adolescent idiopathic scoliosis (AIS) is the most common form of pediatric musculoskeletal disorder. Observational studies have pointed to several risk factors for AIS, but almost no evidence exists to support their causal association with AIS. Here, we applied Mendelian randomization (MR), known to limit bias from confounding and reverse causation, to investigate causal associations between body composition and puberty-related exposures and AIS risk in Europeans and Asians. For our two-sample MR studies, we used single nucleotide polymorphisms (SNPs) associated with body mass index (BMI), waist-hip ratio, lean mass, childhood obesity, bone mineral density (BMD), 25-hydroxyvitamin D (25OHD), age at menarche, and pubertal growth in large European genome-wide association studies (GWAS), and with adult osteoporosis risk and age of menarche in Biobank Japan. We extracted estimates of the aforementioned SNPs on AIS risk from the European or Asian subsets of the largest multiancestry AIS GWAS (N = 7956 cases/88,459 controls). The results of our inverse variance-weighted (IVW) MR estimates suggest no causal association between the aforementioned risk factors and risk of AIS. Pleiotropy-sensitive MR methods yielded similar results. However, restricting our analysis to European females with AIS, we observed a causal association between estimated BMD and the risk of AIS (IVW odds ratio for AIS = 0.1, 95% confidence interval 0.01 to 0.7, p = 0.02 per SD increase in estimated BMD), but this association was no longer significant after adjusting for BMI, body fat mass, and 25OHD and remained significant after adjusting for age at menarche in multivariable MR. In conclusion, we demonstrated a protective causal effect of BMD on AIS risk in females of European ancestry, but this effect was modified by BMI, body fat mass, and 25OHD levels. Future MR studies using larger AIS GWAS are needed to investigate small effects of the aforementioned exposures on AIS. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Incidence of vitamin D deficiency in adolescent idiopathic scoliosis: a meta-analysis

Introduction

This study aimed to investigate the incidence of vitamin D deficiency in patients with adolescent idiopathic scoliosis through a meta-analysis and to analyze trends and risk factors.

Methods

Potentially relevant studies were searched using the terms "Vitamin D AND scoliosis." Data on the incidence and risk factors, such as race, curve magnitude, and sex, were extracted from the selected studies. Review Manager 5.4 software was used for the data analysis. Six studies with a total of 1, 428 patients met the inclusion criteria.

Results

The incidence of vitamin D insufficiency in patients with idiopathic scoliosis was 36.19% (95% CI [21.93 to 50.46]. In contrast, the incidence of vitamin D deficiency was 41.43% (95% CI [16.62 66.23]. Vitamin D levels were compared between Caucasian and African patients and it was concluded that Caucasian patients had a lower risk of vitamin D deficiency [RR 0.15, 95% CI (0.03 to 0.82; P = 0.03]. There was also an association between patients with idiopathic scoliosis and lower vitamin D -5.58, 95% CI [-7.10, -4.06]. Finally, no significant differences were observed in terms of curve magnitude assessed with the Cobb angle mean difference (MD) 4.45, 95% CI [-0.55, 9.44], or sex with lower-than-normal levels of vitamin D OR 0.96, 95% CI [0.58 to 1.60].

Discussion

The incidence rates of vitamin D insufficiency and deficiency in patients with adolescent idiopathic scoliosis were 36.19% and 41.43%, respectively. The Caucasian race was associated with a lower risk of vitamin D deficiency compared to the African race. Vitamin D deficiency was not related to curve magnitude or sex.

Vitamin D in adolescent idiopathic scoliosis: a meta-analysis

OBJECTIVE

The aim of this study was to compare serum vitamin D levels in girls with adolescent idiopathic scoliosis (AIS) and controls using meta-analysis methods. We searched Medline (via PubMed), Cochrane, Scopus, and Embase databases for studies evaluating outcomes in AIS, including patient age, body mass index, bone mineral density (BMD), and serum levels of parathyroid hormone (PTH), calcium, and phosphate, published between January 2000 and June 2020. We searched for studies that were limited to humans only. The inclusion criteria were a scoliosis study that measured vitamin D levels. We excluded duplicate publications such as review articles, case reports, and letters without original data. Two authors extracted data independently and resolved any discrepancies by consensus.

RESULTS

Eight comparative studies were identified. Demographic characteristics, bone density, serum levels of vitamin D, parathyroid hormone, and phosphate levels were not significantly different between AIS group and controls, except for serum calcium levels. The serum calcium levels were lower in AIS group than in the controls.

CONCLUSIONS

This review includes eight comparative studies reporting serum vitamin D and/or parathyroid hormone levels in AIS. Due to heterogeneity, a limited number of meta-analyses have shown a weak correlation between serum vitamin D levels and the incidence of AIS. Larger, multicenter studies are therefore needed to validate the results.

Associations of physical activity and screen time with adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS.

METHODS

A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS.

RESULTS

Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61).

CONCLUSIONS

This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

Genetic Determinants of 25-Hydroxyvitamin D Concentrations and Their Relevance to Public Health

Twin studies suggest a considerable genetic contribution to the variability in 25-hydroxyvitamin D (25(OH)D) concentrations, reporting heritability estimates up to 80% in some studies. While genome-wide association studies (GWAS) suggest notably lower rates (13−16%), they have identified many independent variants that associate with serum 25(OH)D concentrations. These discoveries have provided some novel insight into the metabolic pathway, and in this review we outline findings from GWAS studies to date with a particular focus on 35 variants which have provided replicating evidence for an association with 25(OH)D across independent large-scale analyses. Some of the 25(OH)D associating variants are linked directly to the vitamin D metabolic pathway, while others may reflect differences in storage capacity, lipid metabolism, and pathways reflecting skin properties. By constructing a genetic score including these 25(OH)D associated variants we show that genetic differences in 25(OH)D concentrations persist across the seasons, and the odds of having low concentrations (<50 nmol/L) are about halved for individuals in the highest 20% of vitamin D genetic score compared to the lowest quintile, an impact which may have notable influences on retaining adequate levels. We also discuss recent studies on personalized approaches to vitamin D supplementation and show how Mendelian randomization studies can help inform public health strategies to reduce adverse health impacts of vitamin D deficiency.

Controlling the Progression of Curvature in Children and Adolescent Idiopathic Scoliosis Following the Administration of Melatonin, Calcium, and Vitamin D

Idiopathic scoliosis affects a severe number of children. Their quality of life and development are also disturbed. Some therapeutic strategies have been developed to control illness progression and to optimize the quality of life. In this perspective, randomized, case-control, interventional study, the impact of using melatonin, calcium, and vitamin D, respectively, on idiopathic scoliosis patients was analyzed. Our preliminary results showed that these drugs positively affected the illness progression quantified by the spine curvature. Patients with idiopathic scoliosis may benefit from a novel treatment by supplementation with vitamin D, calcium, and melatonin.

Salivary Progesterone Levels in Female Patients with a History of Idiopathic Scoliosis: A Retrospective Cross-Sectional Study

Idiopathic scoliosis is a condition characterized by a three-dimensional curvature of the spine. However, in addition to the spinal curvature, it has also been reported that patients with idiopathic scoliosis can display other abnormal physiologic parameters, such as hormone imbalances, genetic variants, and micronutrient deficiencies. The present study evaluates the salivary progesterone levels from a historical cohort of patients seeking treatment at a single integrative medicine clinic. A group of female patients with a history of idiopathic scoliosis is compared to a group of non-scoliosis female patients. Salivary progesterone levels were 49% higher in non-scoliosis patients compared to the scoliosis group (p < 0.05). When compared by the menstrual cycling status, non-scoliosis females had a 60% higher average progesterone level, while the progesterone level among non-cycling, non-scoliosis females was 39% higher than non-cycling scoliosis females. These results suggest a potential relationship between salivary progesterone and idiopathic scoliosis among female patients.

Retrospective study of patterns of vitamin D testing and status at a single institution paediatric orthopaedics and sports clinics

OBJECTIVES

There has been a recent increase in awareness of the importance of bone health in children treated by paediatric orthopaedic and sports medicine providers. The purpose of this study was to assess our utilisation of 25 hydroxy vitamin D (25(OH)Vit D) testing in the past 10 years, and to evaluate the level of 25(OH)Vit D sufficiency in various populations of patients seen.

DESIGN

This is a single site, retrospective medical record review study.

SETTING

The study took place at a single large, private, paediatric level 1 trauma teaching hospital in the Northeast USA.

PARTICIPANTS

Our internal medical records query system identified all patients who have had 25(OH)Vit D testing in the past 10 years, from 1 January 2009 to 31 December 2018. All patients included were seen on an outpatient basis at our Orthopaedic clinics.

INTERVENTIONS

No interventions for strict research, however, eligible patients have had 25(OH)Vit D testing during their standard of care treatment.

MAIN OUTCOME MEASURES

The varying number of 25(OH)Vit D testing that occurred over the study time period within Orthopaedic groups, and by Vit D levels as sufficient, insufficient and deficient. 25(OH)Vit D sufficiency was ≥30 ng/mL, insufficiency <30 ng/mL and deficiency were <20 ng/mL. Patients were stratified and analysed.

RESULTS

Between 2009 and 2018, there were 4426 patients who had 25(OH)Vit D testing. Vitamin D testing increased significantly (p<0.001) in the past 10 years. 43% of patients had sufficient 25(OH)Vit D levels, 41% had insufficient levels and 15% had deficient levels.

CONCLUSION

More frequent testing has led to an increased identification of patients with insufficient and deficient 25(OH)Vit D levels. We found over 50% of patients tested were found to have 25(OH)Vit D levels under 30 ng/mL. There should be an increased awareness of patients with orthopaedic problems who may present with 25(OH) insufficiency.

The Role of Vitamins in Neurodegenerative Disease: An Update

Acquiring the recommended daily allowance of vitamins is crucial for maintaining homeostatic balance in humans and other animals. A deficiency in or dysregulation of vitamins adversely affects the neuronal metabolism, which may lead to neurodegenerative diseases. In this article, we discuss how novel vitamin-based approaches aid in attenuating abnormal neuronal functioning in neurodegeneration-based brain diseases such as Alzheimer's disease, Parkinson's disease, Huntington's disease, Amyotrophic lateral sclerosis, and Prion disease. Vitamins show their therapeutic activity in Parkinson's disease by antioxidative and anti-inflammatory activity. In addition, different water- and lipid-soluble vitamins have also prevented amyloid beta and tau pathology. On the other hand, some results also show no correlation between vitamin action and the prevention of neurodegenerative diseases. Some vitamins also exhibit toxic activity too. This review discusses both the beneficial and null effects of vitamin supplementation for neurological disorders. The detailed mechanism of action of both water- and lipid-soluble vitamins is addressed in the manuscript. Hormesis is also an essential factor that is very helpful to determine the effective dose of vitamins. PubMed, Google Scholar, Web of Science, and Scopus were employed to conduct the literature search of original articles, review articles, and meta-analyses.

What Is New in Pediatric Bone Health

BACKGROUND

This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine.

METHODS

A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included.

RESULTS

A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred.

CONCLUSIONS

Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.

Vitamin D levels and pain outcomes in adolescent idiopathic scoliosis patients undergoing spine fusion

PURPOSE

Prior research has indicated adolescent idiopathic scoliosis (AIS) patients have lower bone mineral density and lower vitamin D levels than healthy peers. Vitamin D deficiency has been associated with higher levels of pain. This study investigated whether vitamin D-deficient AIS patients had higher pain before or immediately after posterior spine fusion (PSF) surgery.

METHODS

25-Hydroxy vitamin D levels were tested in all AIS patients at their pre-operative appointment. Patients were grouped by serum 25-hydroxy vitamin D level: deficient, < 20 ng/mL; insufficient, 20-29 ng/mL; sufficient, ≥ 30 ng/mL. Primary outcomes included pre-operative Scoliosis Research Society Health-Related Quality of Life (SRS-30) and numeric rating scale (NRS) scores (0-10) up to 72 h post-operatively, and analyzed using ANOVA and linear mixed modeling, respectively. 176 patients undergoing PSF were included. Intra-operative characteristics by vitamin D status were also assessed. The cohort was 82% female and an average of 15.2 years (range 10.6-25.3 years) at fusion. Average major curve was 60 (range 40-104) degrees pre-operatively.

RESULTS

Forty-five (26%) patients were deficient in vitamin D, 75 (43%) were insufficient, and 56 (32%) were sufficient. Patients with vitamin D deficiency had lower average household income by zip code (p < 0.01) and higher secondhand smoke exposure (p < 0.001). There were no differences in pre-operative SRS-30 score, pre- and post-operative major curve angles, or estimated blood loss across vitamin D groups. Trajectories of NRS indicated no differences in pain during the first 72 h after surgery.

CONCLUSION

Vitamin D deficiency in this population is associated with potential markers of lower socioeconomic status; however, it does not influence AIS PSF patients' experience of pain before or immediately after spine fusion surgery.

LEVEL OF EVIDENCE

II.

Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature

OBJECTIVES

The purpose of this study was to evaluate the impact of recombinant human growth hormone (rhGH) on the development and progression of scoliosis in patients with idiopathic short stature (ISS).

METHODS

Patients with ISS who underwent rhGH treatment from 1997 to 2017 and were followed up for scoliosis screening with serial radiographic examination were included. For assessing scoliosis development, patients who did not have scoliosis at the time of rhGH treatment were included and followed up to determine whether de novo scoliosis developed during the treatment. For evaluating scoliosis progression, patients who already had scoliosis were analyzed. Univariate and multivariate Cox regression analyses of demographic and radiographic variables were performed to determine the related factors in the development and progression of scoliosis.

RESULTS

For assessing scoliosis development, 1093 patients were included. The average duration of rhGH treatment was about 2 years. De novo scoliosis developed in 32 patients (3.7%). The analysis revealed that sex (p=0.016) and chronological age (p=0.048) were statistically significant factors associated with scoliosis development. However, no relationship was observed between scoliosis development and rhGH treatment types or duration. Among 67 patients who already had scoliosis at the time of rhGH treatment, 11 (16.4%) showed scoliosis progression. However, the rhGH types and duration also did not affect scoliosis progression.

CONCLUSIONS

De novo scoliosis developed in 3.7% and scoliosis progressed in 16.4% of the patients during rhGH treatment. However, scoliosis development or progression was not affected by the types or duration of rhGH treatment in patients with ISS.

Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis

Etiology of adolescent idiopathic scoliosis (AIS), a complicated three-dimensional spinal deformity with early-onset, receives continuous attention but remains unclear. To gain an insight into AIS pathogenesis, this review searched PubMed database up to June 2019, using key words or medical subject headings terms including "adolescent idiopathic scoliosis," "scoliosis," "pathogenesis," "etiology," "genetics," "mesenchymal stem cells," and their combinations, summarized existing literatures and categorized the theories or hypothesis into nine aspects. These aspects include bone marrow mesenchymal stem cell studies, genetic studies, tissue analysis, spine biomechanics measurements, neurologic analysis, hormone studies, biochemical analysis, environmental factor analysis, and lifestyle explorations. These categories could be a guidance for further etiology or treatment researches to gain inspiration.

Assessment of serum vitamin D levels in surgical adolescent idiopathic scoliosis patients

BACKGROUND

The mechanism behind idiopathic scoliosis and its progression is not fully understood. Vitamin D insufficiency is known to play a role in the progression and/or occurrence of a variety of bone diseases. In this study, we aimed to estimate the prevalence of vitamin D insufficiency among patients with adolescent idiopathic scoliosis. Additionally, we aimed to calculate the differences in serum vitamin D levels, Cobb angles, spinal bone mass densities, and serum alkaline phosphatase levels between the sexes in the sample and to assess the possibility of a correlation between any of these factors.

METHODS

Demographic details, vitamin D levels, Cobb angle, spinal bone mass density, and alkaline phosphatase were collected from the records of 67 patients who were eligible for corrective surgery. These values were compared to normal levels and between the sexes within the study.

RESULTS

Of the 67 patients, 54 (80.6%) were female. The mean serum vitamin D level was 37.86 ± 26 nmol/L, and levels below normal were found in 92.5% of the patients. Statistical analysis showed significant differences (p = 0.002) in serum alkaline phosphatase levels between the sexes. No correlation was found between vitamin D levels and the Cobb angles, spinal and bilateral femoral neck bone mass densities, and serum alkaline phosphatase levels.

CONCLUSIONS

Most adolescent idiopathic scoliosis patients had insufficient serum vitamin D levels and also suffered from low bone mineral density at an early age.

Pulmonary non-tuberculous mycobacterial infections: current state and future management

Currently, there is a trend of increasing incidence in pulmonary non-tuberculous mycobacterial infections (PNTM) together with a decrease in tuberculosis (TB) incidence, particularly in developed countries. The prevalence of PNTM in underdeveloped and developing countries remains unclear as there is still a lack of detection methods that could clearly diagnose PNTM applicable in these low-resource settings. Since non-tuberculous mycobacteria (NTM) are environmental pathogens, the vicinity favouring host-pathogen interactions is known as important predisposing factor for PNTM. The ongoing changes in world population, as well as socio-political and economic factors, are linked to the rise in the incidence of PNTM. Development is an important factor for the improvement of population well-being, but it has also been linked, in general, to detrimental environmental consequences, including the rise of emergent (usually neglected) infectious diseases, such as PNTM. The rise of neglected PNTM infections requires the expansion of the current efforts on the development of diagnostics, therapies and vaccines for mycobacterial diseases, which at present, are mainly focused on TB. This review discuss the current situation of PNTM and its predisposing factors, as well as the efforts and challenges for their control.

Nutrition and physical activity level of adolescents with idiopathic scoliosis: a narrative review

Some studies have shown that patients with adolescent idiopathic scoliosis (AIS) have different anthropometric features compared with their peers such as taller stature, lower body mass index, and bone mineral density. Yet the causes explaining these differences remain uncertain. Nutritional intake and status, combined with physical activity, could explain these discrepancies. We aimed to review the current literature on energy and nutrient intake, on nutritional status and physical activity in relation to AIS and to discuss study methodologies and propose avenues for future studies. Studies describing energy or nutrient intake in AIS mostly focused on total energy and calcium and found no difference between AIS and control cohorts. Regarding nutritional status, it was found that AIS patients have lower vitamin D levels than controls and that most patients have insufficient or deficient vitamin D serum levels. Lower concentration of parathyroid hormones and calcitonin were also found in AIS compared to controls as well as anomalies in trace elements. In the studies that have assessed physical activity, three found that AIS girls were less active than controls, but four did not observe differences between groups. In this review, we highlight that nutrition and physical activity are important topics in AIS that require further research as they could help understand anthropometric discrepancies and disease etiology.

Assessment of Static Plantar Pressure, Stabilometry, Vitamin D and Bone Mineral Density in Female Adolescents with Moderate Idiopathic Scoliosis

(1) Background: Adolescent idiopathic scoliosis (AIS) can be associated with vitamin D deficiency and osteopenia. Plantar pressure and stabilometry offer important information about posture. The objectives of our study were to compare static plantar pressure and stabilometric parameters, serum 25-OH-vitamin D3 and calcium levels, and bone mineral densitometry expressed as z-score in patients with moderate AIS and healthy subjects. (2) Methods: 32 female adolescents (idiopathic S shaped moderate scoliosis, main lumbar curve) and 32 gender and age-matched controls performed: static plantar pressure, stabilometry, serum 25-OH-vitamin D3 and calcium levels, and dual X-ray absorptiometry scans of the spine. (3) Results: In scoliosis patients, significant differences were recorded between right and left foot for total foot, first and fifth metatarsal, and heel loadings. Stabilometry showed a poorer postural control when compared to healthy subjects (p < 0.001). Patients had significantly lower vitamin D, calcium levels, and z-scores. Lumbar Cobb angle was significantly correlated with the z-score (r = −0.39, p = 0.02), with right foot fifth metatarsal load (r = −0.35, p = 0.04), center of pressure CoP_x (r = −0.42, p = 0.01), CoP displacement (r = 0.35, p = 0.04) and 90% confidence ellipse area (r = −0.38, p = 0.03). (4) Conclusions: In our study including female adolescents with idiopathic S shaped moderate scoliosis, plantar pressure and stabilometric parameters were influenced by the main scoliotic curve.

Association between calcium-phosphorus balance and adolescent idiopathic scoliosis: A meta-analysis

STUDY DESIGN

A systematic review and meta-analysis.

OBJECTIVE

The objective of this meta-analysis was to evaluate the association between calcium-phosphorus balance and adolescent idiopathic scoliosis (AIS).

METHODS

Databases, including PubMed, OVID database, Web of Science, CBM database and CNKI database were searched for the relevant case control studies and cross-sectional studies. Two authors selected studies and extracted data independently. Data analysis was performed by Review Manager Software 5.0. Subgroup analysis was performed on the serum level of vitamin D according to gender and menstruation.

RESULTS

Five studies were included, with a total of 646 cases of AIS and 791 controls. AIS group had a lower serum level of vitamin D compared to control group [MD = -6.74, 95% CI (-9.47, -4.00)]. Gender and menstruation condition were thought to have no effect on the primary outcome of vitamin D level by subgroup analysis [MD = -5.97, 95% CI (7.61, -4.34)]. The AIS group had a lower calcium level [SMD= -0.77, 95% CI (-1.51, -0.02)] and calcitonin level compared to control group. There was no statistical difference in phosphorus level [SMD=0.5, 95% CI (-0.46, 0.57)] and parathyroid hormone level [SMD = -0.11, 95% CI (-0.54, -0.31)]. Meanwhile, the observational indexes, including serum levels of calcium, phosphorus, parathyroid hormone and calcitonin were within normal limits.

CONCLUSION

Vitamin D deficiency may be involved in the pathogenesis of AIS by influencing the regulation of calcium-phosphors metabolism on human bone. Therefore, we suggest to screen vitamin D level in AIS patients.

LEVEL OF EVIDENCE

Level III, Therapeutic Study.