Association between Bone Turnover Markers, Leptin, and Nutritional Status in Girls with Adolescent Idiopathic Scoliosis (AIS)

Abstract

The link between scoliotic deformity and bone metabolism in adolescent idiopathic scoliosis (AIS) has not been well researched. Moreover, the data concerning the cross-talk between fat tissue content/hormonal activity and bone markers in this group of patients are lacking. The aim of the study was to assess whether there exists a significant relationship between the severity of AIS and bone turnover markers and leptin levels. The study group was consisted of 77 AIS girls, aged 14.7 ± 2.17 years. Scoliotic curve severity assessed by Cobb’s angle was categorized as mild (10–19°), moderate (20–39°), or severe (≥40°). Corrected height, weight, and waist and hip circumferences were measured and body mass index (BMI), corrected height Z-score, BMI Z-score, and waist/height ratio (WHtR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM), and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. Bone turnover markers (osteocalcin (OC) and amino terminal of collagen cross-links (NTx) and leptin levels were assessed in serum. Multiple regression analysis showed that, OC, NTx (negatively with p < 0.05), and leptin (positively with p < 0.01) were significantly associated with curve severity in AIS girls. Moreover, Cobb’s angle was positively correlated with W/HtR (p < 0.01) and FAT (p < 0.05). One-way analysis of variance (ANOVA) revealed significant differences in leptin (p < 0.05 vs. mild only), OC (p < 0.05 vs. mild and moderate), and W/HtR (p < 0.01 and p < 0.05 vs. mild and moderate, respectively) between the three AIS severity subgroups. OC was significantly lower in the severe AIS subgroup, while leptin and W/HtR were significantly higher. Significant correlations between leptin and anthropometrical parameters as BMI z-score and W/HtR were shown. Leptin level correlated also significantly with BMI z score (p < 0.001), W/HtR (p < 0.0001), and body composition parameters (p < 0.000001). Moreover, there was a significant negative correlation between NTx and leptin level (p < 0.05). Bone metabolism in AIS girls seems to be altered and significantly related to the scoliotic curve severity. Leptin may be a crucial link in the cross-talk between bone turnover and body composition in this group of patients. Further studies concerning interrelationship between nutritional status and bone metabolism in patients with AIS are warranted.

Is There a Relationship between Idiopathic Scoliosis and Body Mass? A Scoping Review

“…A cross-sectional study [ 26 ] was conducted with the aim of correlating the extent of the severity of the scoliotic curve with markers of bone turnover (osteocalcin (OC) and amino terminal collagen (NTx) crosslinks with respect to leptin level and nutritional status in girls with AIS 77 girls were included in this study with newly diagnosed scoliosis, aged 14.7 ± 2.17 years, divided into three groups based on the Cobb angle detected on radiography (mild scoliosis 10–19°, moderate scoliosis 20–39°, severe scoliosis ≥ 40°). Corrected height, weight and circumferences of waist and hip were measured and BMI, corrected height Z-score, BMI Z-score were calculated (standard deviation number from the 50th percentile) and the waist-to-height ratio (WHtR) for the whole group.…”

“…Idiopathic scoliosis has a high incidence among children all over the world and its multifactorial etiology is now accepted, although to date it is not fully known [ 16 , 23 , 27 , 28 ]. This condition can lead to important changes in the child’s physical appearance with a negative psychological effect on it [ 26 ].…”

“…This is probably because, in predisposed subjects, from the biomechanical point of view, the pushing force of the paravertebral muscles is lost, which is essential to counteract the establishment and evolution of the scoliotic curve [ 26 , 40 , 41 ].…”

“…A further result of our review is that the presence of low body weight would appear to be associated with greater severity of spinal deformities [ 26 ], while on the contrary a higher-than-normal body weight would appear to have a protective effect [ 26 ].…”

Circulatory Adipokines and Incretins in Adolescent Idiopathic Scoliosis: A Pilot Study

“…In recent years, scattered evidence has suggested that one’s metabolism and energy homeostasis is involved in AIS risk, severity, or progression [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Although interesting, this hypothesis has yet been poorly explored.…”