Participation of sex hormones in multifactorial pathogenesis of adolescent idiopathic scoliosis

Int Orthop. 2015 Jun;39(6):1227-36. doi: 10.1007/s00264-015-2742-6. Epub 2015 Mar 25.


Purpose: In order to verify the potential association between the aetiopathogenesis of adolescent idiopathic scoliosis (AIS) and the process of sexual maturation, we determined the concentrations of oestrogens in pre- and postmenarcheal girls affected by this condition. AIS, occurring mostly in pubescent girls, is one of the most frequent forms of faulty posture. Therefore, it was assumed that the multifactorial pathomechanism of AIS involves significant deficiency of oestrogens.

Methods: The diagnosis of AIS was established on the basis of physical examination and analyses of radiograms. Concentrations of FSH, LH, oestrogens, progesterone, osteocalcin and RANKL were determined by ELISA. The activity of alkaline phosphatase (AP) was measured by kinetic method. The study included pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls.

Results: In premenarcheal scoliotic girls, the levels of FSH, LH and oestradiol were lower; the levels of progesterone, oestrone and oestriol were higher; and the concentrations of oestrone and oestriol were similar compared to premenarcheal controls. Higher levels of RANKL, osteocalcin and AP were observed in premenarcheal adolescents with AIS compared to controls. The concentrations of FSH, LH, oestradiol, and progesterone in postmenarcheal girls with scoliosis were lower, oestrone were slightly lower and oestriol did not differ compared with the control group. Significantly higher levels of RANKL, osteocalcin and AP were observed in postmenarcheal scoliotic adolescents compared with controls.

Conclusions: There is an interdependence between the concentration of oestradiol and development of scoliosis. Determination of estradiol may have diagnostic value in the screening of spinal pathologies associated with AIS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Alkaline Phosphatase / blood
  • Child
  • Estrogens / blood
  • Female
  • Follicle Stimulating Hormone / blood
  • Gonadal Steroid Hormones / physiology*
  • Humans
  • Kyphosis
  • Progesterone / blood
  • RANK Ligand / blood
  • Scoliosis / etiology
  • Scoliosis / physiopathology*


  • Estrogens
  • Gonadal Steroid Hormones
  • RANK Ligand
  • TNFSF11 protein, human
  • Progesterone
  • Follicle Stimulating Hormone
  • Alkaline Phosphatase