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Behavior of Scoliosis During Growth in Children with Osteogenesis Imperfecta

Anissipour, Alireza K. DO; Hammerberg, Kim W. MD; Caudill, Angela MPT; Kostiuk, Theodore DO; Tarima, Sergey PhD; Zhao, Heather Shi MS; Krzak, Joseph J. PT; Smith, Peter A. MD

Journal of Bone & Joint Surgery - American Volume: 5 February 2014 - Volume 96 - Issue 3 - p 237–243
doi: 10.2106/JBJS.L.01596
Scientific Articles
Supplementary Content

Background: Spinal deformities are common in patients with osteogenesis imperfecta, a heritable disorder that causes bone fragility. The purpose of this study was to describe the behavior of spinal curvature during growth in patients with osteogenesis imperfecta and establish its relationship to disease severity and medical treatment with bisphosphonates.

Methods: The medical records and radiographs of 316 patients with osteogenesis imperfecta were retrospectively reviewed. The severity of osteogenesis imperfecta was classified with the modified Sillence classification. Serial curve measurements were recorded throughout the follow-up period for each patient with scoliosis. Regression analysis was used to determine the effect of disease severity (Sillence type), patient age, and bisphosphonate treatment on the progression of scoliosis as measured with the Cobb method.

Results: Of the 316 patients with osteogenesis imperfecta, 157 had associated scoliosis, a prevalence of 50%. Scoliosis prevalence (68%) and mean progression rate (6° per year) were the highest in the group of patients with the most severe osteogenesis imperfecta (modified Sillence type III). A group with intermediate osteogenesis imperfecta severity, modified Sillence type IV, demonstrated intermediate scoliosis values (54%, 4° per year). The patient group with the mildest form of osteogenesis imperfecta, modified Sillence type I, had the lowest scoliosis prevalence (39%) and rate of progression (1° per year). Early treatment—before the patient reached the age of six years—of type-III osteogenesis imperfecta with bisphosphonate therapy decreased the curve progression rate by 3.8° per year, which was a significant decrease. Bisphosphonate treatment had no demonstrated beneficial effect on curve behavior in patients with other types of osteogenesis imperfecta or in patients of older age.

Conclusions: The prevalence of scoliosis in association with osteogenesis imperfecta is high. Progression rates of scoliosis in children with osteogenesis imperfecta are variable, depending on the Sillence type of osteogenesis imperfecta. High rates of scoliosis progression in type-III and type-IV osteogenesis imperfecta contrast with a benign course in type I. Bisphosphonate therapy initiated before the patient reaches the age of six years can modulate curve progression in type-III osteogenesis imperfecta.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

1Department of Orthopaedic Surgery, Midwestern University, Chicago College of Osteopathic Medicine, 555 31st Street, Downers Grove, IL 60515. E-mail address for A.K. Anissipour: E-mail address for T. Kostiuk:

2Shriners Hospitals for Children, 2211 North Oak Park Avenue, Chicago, IL 60707. E-mail address for K.W. Hammerberg: E-mail address for A. Caudill: E-mail address for J.J. Krzak: E-mail address for P.A. Smith:

3Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226. E-mail address for S. Tarima: E-mail address for H.S. Zhao:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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