The Role of Vitamin D in Adolescent Idiopathic Scoliosis

Several theories have been proposed to explain the cause of adolescent idiopathic scoliosis (AIS). However there is limited data on the impact of Vitamin D insufficiency or deficiency on scoliosis. We know from previous studies that vitamin D deficiency and insufficiency are prevalent in adolescents, including AIS patients. In fact, it has been shown that as many of 30% of these patients have osteopaenia, where there is reduced bone density. 

Vitamin D and Osteopaenia in AIS 

Currently AIS is considered to be a disease with genetic and environmental influences. Vitamin D deficiency and osteopaenia are prevalent in AIS patients and this is positively correlated with the size of the Cobb angle. So, is it possible that vitamin D deficiency plays a role in AIS development? And is this influenced by other factors such as postural control and regulation of bone metabolism? 

Vitamin D deficiency is also found to reduce postural control. Supplementation of vitamin D improves the postural control in the elderly who have vitamin D deficiency. Does this have any implications for patients with AIS? Right now, there is no evidence and further study is needed in this area. 

Vitamin D may also play a role in the development of AIS because of its effects on bone metabolism. Vitamin D may interact with oestrogen, melatonin and leptin to influence the bone mineral density of the bones, including those of the vertebrae of the spine. 

A recent literature review published in the Asian Spine Journal in 2018 demonstrated an association between vitamin D status and bone mineral density, menarche (first onset of menstruation) and other hormones. It’s important to remember that although the lower vitamin D levels are correlated with Cobb angle, the relationship between vitamin D and AIS may not be causal. We need more studies in this area to really see the true link. But it is interesting to note that so many AIS patients tend to be low in Vitamin D! 

Postural Control, Vitamin D, Vitamin K and AIS 

Postural dysfunctions are observed in some AIS patients. Further studies are required to determine whether vitamin D definitely plays a causal role in the etiopathogenesis of AIS and whether vitamin D deficiency is related to the tethering of the nerve roots and postural control dysfunctions observed in some AIS patients. 

Recently vitamin K2 was also found to be important for regulating bone metabolism. It facilitates the depositing of calcium in the bones. It is noteworthy that healthy adolescents have some vitamin D and vitamin K2 deficiency. It has been postulated that this may be attributed to the high bone turnover of children and fat restricted diets enforced by some parents since the early 1980s that have been thought to reduce the risk of cardiovascular diseases. 

So Now What? 

Right now all we know is that there is sometimes sort of trend for AIS patients to be low in vitamin D and vitamin K2. We know that these patients often have some trouble with postural control and have low bone mineral density for their age. We also know that lower vitamin D levels are correlated with higher Cobb angles, and that giving vitamin D supplementation to the elderly who have postural issues helps. Further studies in this area will be interesting to help determine the exact role, if any, that vitamin D plays in the cause of AIS. Stay tuned! 

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