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Article: Scoliosis in osteogenesis imperfecta: identifying the genetic and non-genetic factors affecting severity and progression from longitudinal data of 290 patients

TitleScoliosis in osteogenesis imperfecta: identifying the genetic and non-genetic factors affecting severity and progression from longitudinal data of 290 patients
Authors
KeywordsGenetics
Logistic regression
Multivariate regression
Osteogenesis imperfecta
Progression rate
Scoliosis
Issue Date20-Sep-2023
PublisherBioMed Central
Citation
Orphanet Journal of Rare Diseases, 2023, v. 18, n. 1 How to Cite?
Abstract

Background

Scoliosis is widely prevalent among osteogenesis imperfecta (OI) patients, and is progressive with age. However, factors affecting scoliosis in OI are not well known.

Methods

We retrospectively retrieved longitudinal radiographic and clinical records of consecutive OI patients seeking treatments at our hospital from 2014 to 2022, graded their pre-operative spinal conditions into four outcome groups, estimated their progression rates, and descriptively and inferentially analyzed the genetic and non-genetic factors that may affect the outcomes and progression rates.

Results

In all, 290 OI patients met the inclusion criteria, where 221 had genetic records. Of these 221, about 2/3 had mutations in COL1A1 or COL1A2, followed by mutations in WNT1 (9.0%), IFITM5 (9.0%) and other OI risk genes. With an average age of 12.0 years (interquartile range [IQR] 6.9–16.1), 70.7% of the cohort had scoliosis (Cobb angle > 10°), including 106 (36.5%) mild (10°–25°), 40 (13.8%) moderate (25°–50°), and 59 (20.3%) severe (> 50°) scoliosis patients. Patients with either COL1A1 and COL1A2 were strongly biased toward having mild or no scoliosis, whereas patients with mutations in IFITM5WNT1 and other recessive genes were more evenly distributed among the four outcome grades. Lower-limb discrepancy, bone mineral density (BMD) and age of first drug used were all significantly correlated with severity outcomes. Using multivariate logistic regression, we estimated that each year older adds an odds ratio of 1.13 (95% confidence interval [CI] 1.07–1.2) in progression into advanced stages of scoliosis. We estimated a cohort-wide progression rate of 2.7 degrees per year (95% CI 2.4–3.0). Early-onset patients experienced fast progressions during both infantile and adolescent stages. Twenty-five of the 59 (42.8%) patients with severe scoliosis underwent spinal surgeries, enjoying an average Cobb angle reduction of 33° (IQR 23–40) postoperatively.

Conclusion

The severity and progression of scoliosis in osteogenesis imperfecta were affected by genetic factors including genotypes and mutation types, and non-genetic factors including age and BMD. As compared with COL1A1, mutations in COL1A2 were less damaging while those on IFITM5 and other recessive genes conferred damaging effects. Progression rates were the fastest in the adolescent adult age-group.


Persistent Identifierhttp://hdl.handle.net/10722/340084
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.182
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChen, P-
dc.contributor.authorZhou, Y-
dc.contributor.authorTan, Z-
dc.contributor.authorLin, Y-
dc.contributor.authorLin, DL-
dc.contributor.authorWu, J-
dc.contributor.authorLi, Z-
dc.contributor.authorShek, HT-
dc.contributor.authorWu, J-
dc.contributor.authorHu, Y-
dc.contributor.authorZhu, F-
dc.contributor.authorChan, D-
dc.contributor.authorCheung, KM-
dc.contributor.authorTo, MK-
dc.date.accessioned2024-03-11T10:41:32Z-
dc.date.available2024-03-11T10:41:32Z-
dc.date.issued2023-09-20-
dc.identifier.citationOrphanet Journal of Rare Diseases, 2023, v. 18, n. 1-
dc.identifier.issn1750-1172-
dc.identifier.urihttp://hdl.handle.net/10722/340084-
dc.description.abstract<h3>Background</h3><p>Scoliosis is widely prevalent among osteogenesis imperfecta (OI) patients, and is progressive with age. However, factors affecting scoliosis in OI are not well known.</p><h3>Methods</h3><p>We retrospectively retrieved longitudinal radiographic and clinical records of consecutive OI patients seeking treatments at our hospital from 2014 to 2022, graded their pre-operative spinal conditions into four outcome groups, estimated their progression rates, and descriptively and inferentially analyzed the genetic and non-genetic factors that may affect the outcomes and progression rates.</p><h3>Results</h3><p>In all, 290 OI patients met the inclusion criteria, where 221 had genetic records. Of these 221, about 2/3 had mutations in <em>COL1A1</em> or <em>COL1A2</em>, followed by mutations in <em>WNT1</em> (9.0%), <em>IFITM5</em> (9.0%) and other OI risk genes. With an average age of 12.0 years (interquartile range [IQR] 6.9–16.1), 70.7% of the cohort had scoliosis (Cobb angle > 10°), including 106 (36.5%) mild (10°–25°), 40 (13.8%) moderate (25°–50°), and 59 (20.3%) severe (> 50°) scoliosis patients. Patients with either <em>COL1A1</em> and <em>COL1A2</em> were strongly biased toward having mild or no scoliosis, whereas patients with mutations in <em>IFITM5</em>, <em>WNT1</em> and other recessive genes were more evenly distributed among the four outcome grades. Lower-limb discrepancy, bone mineral density (BMD) and age of first drug used were all significantly correlated with severity outcomes. Using multivariate logistic regression, we estimated that each year older adds an odds ratio of 1.13 (95% confidence interval [CI] 1.07–1.2) in progression into advanced stages of scoliosis. We estimated a cohort-wide progression rate of 2.7 degrees per year (95% CI 2.4–3.0). Early-onset patients experienced fast progressions during both infantile and adolescent stages. Twenty-five of the 59 (42.8%) patients with severe scoliosis underwent spinal surgeries, enjoying an average Cobb angle reduction of 33° (IQR 23–40) postoperatively.</p><h3>Conclusion</h3><p>The severity and progression of scoliosis in osteogenesis imperfecta were affected by genetic factors including genotypes and mutation types, and non-genetic factors including age and BMD. As compared with <em>COL1A1</em>, mutations in <em>COL1A2</em> were less damaging while those on <em>IFITM5</em> and other recessive genes conferred damaging effects. Progression rates were the fastest in the adolescent adult age-group.</p>-
dc.languageeng-
dc.publisherBioMed Central-
dc.relation.ispartofOrphanet Journal of Rare Diseases-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectGenetics-
dc.subjectLogistic regression-
dc.subjectMultivariate regression-
dc.subjectOsteogenesis imperfecta-
dc.subjectProgression rate-
dc.subjectScoliosis-
dc.titleScoliosis in osteogenesis imperfecta: identifying the genetic and non-genetic factors affecting severity and progression from longitudinal data of 290 patients-
dc.typeArticle-
dc.identifier.doi10.1186/s13023-023-02906-z-
dc.identifier.scopuseid_2-s2.0-85171810518-
dc.identifier.volume18-
dc.identifier.issue1-
dc.identifier.eissn1750-1172-
dc.identifier.isiWOS:001072284500001-
dc.identifier.issnl1750-1172-

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