Tuesday, July 28, 2015

Teenage Scoliosis Associated with Low Bone Quality

A new research study published in the Journal of Manipulative Medicine in July 2015, reveals that bone
quality is lower in teenagers suffering from adolescent idiopathic scoliosis (AIS) (1). This study measured ultrasound sound waves traveling through the bones to compare bone quality to conduct sound in two groups, patient with AIS and control patients with no scoliosis.

In general the patients in the AIS group had lower measured sound values compared to the control group indicating they had a lower bone quality compared to individuals without scoliosis. In addition, 25% of the AIS group were found to have low bone quality however the curve type and magnitude of the curve were not shown to be a factor in bone quality. There was also a correlation found in bone quality between those in the AIS group that had begun menstruation and those that had not begun menstruation.

The researchers concluded that AIS patients may have lower bone quality due to slower bone maturation. However, I think more research needs to be conducted on the "WHY" they have a slower bone maturation, but I do have a hypothesis to present. In many of the children and adult with scoliosis that I've seen in my office, there are some serious nutritional deficiencies and gut flora imbalances that can lead to reduced growth and healing rates as well as impact muscle function that can contribute to spinal curvatures.

For instance, there have been studies that have linked low levels of Vitamin D with AIS (2). There has also been research on melatonin deficiency linked to AIS, however some controversy exists as circulating levels of melatonin are no different for those with or without AIS but the osteoblasts (bone building cells in bones) melatonin signaling in those with AIS shows impairment and distinct mutations that can effect melatonin signalling. (3) This last study looking at melatonin and mutations may yield more information about a genetic factor for scoliosis as in some cases you may see this conditions run in families.

In moving forward with a more active care approach to scoliosis, I think practitioners need to focus on an integrative treatment approach blending chiropractic care to restore joint mobility, diet and nutritional assessments to check for nutritional deficiencies and make dietary recommendations, and functional exercise aimed at balancing spinal musculature bilaterally to restore normal posture and positioning would be the best answer to a multi-facted problem. Our current medical approach of watch and wait until it gets bad enough to require surgery (which is a completely different issue in itself) is NOT good enough. Every patient deserves to know their options when it comes to their health including alternative care options and they should DEMAND to make an informed choice on what treatment(s) they will consent to.

Resources:
1. Du et al. "Qualitative Measurements of Bone Quality in Female Adolescents with Idiopathic Scoliosis Compared to Normal Controls" 2015 Jul 18. pii: S0161-4754(15)00074-3.

2. Batista et al. "Association between Vitamin D levels and Adolescent Idiopathic Scoliosis". Scoliosis. 2014; 9(Suppl 1): O45. Click Here to Read More

3. Moreau et al. "Melatonin Signaling Dysfunction in Adolescent Idiopathic Scoliosis".  2004 Aug 15;29(16):1772-81. Click Here to Read More