One of the 2022 Thomas E. Whitecloud Awards was presented by the Scoliosis Research Society to a truly global scientific collaboration (representing Northwestern University, Nanjing University Medical School, The Chinese University of Hong Kong, Towson University, University of Miami and the MD Anderson Cancer Center) for their study of the role that vitamin D deficiency plays in the onset of adolescent idiopathic scoliosis.
The award, named after IMAST (International Meeting on Advanced Spine Techniques) co-founder Dr. Thomas E. Whitecloud, is given to the best basic science/translational and best clinical papers. This year’s winner for best basic science/translational research paper went to Zhen Liu, M.D.; Jie Li, M.D.; Zhikai Qian, M.D.; Ziyang Tang, M.D.; Kiram Abdukahar, M.D.; Zongshan Hu, Ph.D.; Zezhang Zhu, M.D.; Yong Qiu, M.D.; Jian Cao, Assistant Professor.
Dr. Zhen Liu told OTW, “As identified in our previous studies, low low bone mineral density [BMD] and abnormal bone homeostasis are the key features of adolescent idiopathic scoliosis patients.”
“Low bone mineral density was reportedly related to the curve progression and treatment outcomes of bracing. And recent evidence suggested that vitamin D deficiency is prevalent in adolescent idiopathic scoliosis patients and correlated with bone mineral density.”
“And we would like to mention that our collaborator, Prof T.P. Lam from the joint scoliosis research center (Nanjing University and the Chinese University of Hong Kong), has also run a randomized controlled trial (RCT) on vitamin D supplementation in adolescent idiopathic scoliosis patients with positive findings.”
“But the limitation of the current literature is the relatively small sample size, which requires further validation. And the research gap now is the missing connection between bone turnover markers, vitamin D deficiency, and scoliosis development.”
“Hence, we designed the current study to further answer this question using a valid model for adolescent idiopathic scoliosis. The findings are actually a proof-of-concept study, which also echoes the previous RCT performed on adolescent idiopathic scoliosis patients clinically.”
And what did we know before their study?
Co-author Dr. Zhen Liu explained to OTW how much has been learned from earlier studies and how this new research built on that foundation: “Previous studies have reported vitamin D insufficiency and deficiency in different adolescent idiopathic scoliosis patient groups. And some of these studies showed a correlation between vitamin D levels and the Cobb angle, and bone mineral density.”
“The serum vitamin D levels before puberty were also found to predict the bone mineral content at 15 years old in adolescent idiopathic scoliosis patients. Another potential link between vitamin D and adolescent idiopathic scoliosis is the polymorphism of vitamin D receptors, which has been also identified by our team.”
“However, there are also studies reporting the lack of the correlation between vitamin D and bone mineral density in adolescent idiopathic scoliosis, and other bone turnover markers including alkaline phosphatase, or calcium. So overall, we would confirm that vitamin D deficiency or insufficiency is present in adolescent idiopathic scoliosis, but its correlations with BMD and other related markers of bone homeostasis are not yet conclusive, which requires further validation by multicenter study of large sample size.”
What questions remain to be answered in order to move this research into the clinic?
Moving forward, Dr. Liu explained: “We would like to perform a rescue experiment in the current animal study, to find out if the vitamin D deficiency in adolescent idiopathic scoliosis development was in early stages, and if this can be rescued or not. The second step will be to include bone homeostasis parameters, like calcium and bone mineralization rate, to make our study more complete.”
As for when orthopedic surgeons begin recommending vitamin D for their scoliosis patients, Dr. Liu observed; “I would say based on our current evidence we cannot yet jump to the clinical recommendations in real treatment. Overall, when combining the findings from the clinical and basic studies, the important role of vitamin D is confirmative. However, still, there are questions to be answered, including the indication for supplementation, for example, for deficiency patients only or can also be used for insufficiency patients? For earlier diagnosed patients or those reached skeletal maturity? And the dosage of vitamin D to supplement and combination with calcium still need further justification.”
“And we are also trying to solve these potential questions and start clinical validation in later multicenter studies. As vitamin D is available and frequently used as nutrition supplements clinically, we believe that this therapy can be applied in the indicated patients in the very near future.”
