Calcium, vitamin D and Adolescent Idiopathic Scoliosis (AIS)- do calcium and vitamin D levels predict curve progression in AIS?
Rosemary Marchese – Physiotherapist, Certified Schroth Physiotherapist (C2)
Adolescent Idiopathic Scoliosis (AIS) is associated with low bone mass. The therapeutic effect and its determinants of calcium and vitamin D supplementation in improving bone strength and preventing curve progression in AIS is gaining more and more support through research. One of the more recent studies was published by Lam and colleagues in 2017. The study provided strong evidence that calcium and vitamin D supplementation can improve bone strength in AIS and may help minimise curve progression.
Do children with AIS have low bone density?
Overall, bone metabolism and density in AIS has not been well described, and the studies that do exist often have some flaws. A longitudinal cohort study of 513 patients found that osteopaenia (a condition that occurs when the body doesn’t make new bone as quickly as it reabsorbs old bone) was found to occur in approximately 30 percent of AIS patients. Having low bone density was recognised as a prognostic factor for curve progression reaching surgical threshold of 45 degrees. In other words, AIS patients who had osteopaenia had significantly higher risk of indication of surgery (Yip et al, 2016).
‘Low bone density is considered to be associated with higher risk of curve progression in AIS.’
In another study it was shown that 65% of AIS patients had osteopaenia or osteoporosis (a condition in which bones become weak and brittle). Higher rates of bone resorption (when the bones break down faster than they are strengthened) are associated with low bone density in AIS patients (Ko Ishida et al, 2015)
Should we supplement with Vitamin D and Calcium?
The therapeutic effect of supplementing with Vitamin D and Calcium in an attempt to affect curves in AIS may be of particular interest to parents of these children who are looking for additional ways to help minimise curve progression. When comparing the outcomes of not taking supplements, taking a low dose supplement or taking a high dose supplement, the results are listed below:
- 47% of the placebo group progressed
- 24% of the low dose group progressed
- 22% of the higher dose group progressed
The high dose group were taking 600 mg of calcium and 800IU Vitamin D per day (Lam et al 2017).
Should you supplement your child with Vitamin D and Calcium?
There is no one-size-fits-all approach for AIS. However, I think it’s important parent question whether or not their child’s bone density needs investigating, particularly if they are low body weight. The data provided above is for informational purposes and I do encourage parents to take note and consider all evidence when choosing treatment for their child with AIS. Please do not hesitate to contact your Schroth Physiotherapist however if you have any questions.
Is supplementation the only conservative treatment option?
No, please remember that Schroth Physiotherapy, and in some cases, bracing, are therapies that are recommended for scoliosis by SOSORT (The Society of Scoliosis Orthopedic and Rehabilitation Treatment).
Yip et al (2016). Prognostic Value of Bone Mineral Density on Curve Progression: A Longitudinal Cohort Study of 513 Girls with Adolescent Idiopathic Scoliosis. Scientific Reports volume6, Article number: 39220
Ishida K et al (2015). Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis, Scoliosis 2015, 10:9, DOI:10.1186/s13013-015-0033-z.
Effective therapeutic control of curve progression using calcium and vitamin D supplementation for adolescent idiopathic scoliosis – a randomized double-blinded placebo-controlled trial. Lam et al (2017). Bone Abstracts 6 OC8 | DOI: 10.1530/boneabs.6.OC8