Abstract
Scoliosis exists as a three-dimensional spinal deformity which develops through the combination of genetic elements, endocrine factors, biomechanical forces, and nutritional components. Research shows that bone mineral density (BMD) reduction exists as a widespread condition throughout adolescent idiopathic scoliosis (AIS), congenital scoliosis, and neuromuscular scoliosis patients. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative CT scans show that bone density is lower in both cortical and trabecular areas while microarchitectural changes occur which could lead to spinal curve development and growth. The development of skeletal abnormalities results from multiple biological pathways. Research studies using genome-wide and candidate-gene approaches have identified LRP5, VDR, COL1A1, and other essential genes which control osteoblast development and matrix structure. The process of bone formation receives additional influence from epigenetic changes which affect the methylation patterns of osteogenic transcription factors and estrogen-related genes. The specific microRNA patterns found in AIS patients disrupt BMP and SMAD signaling pathways which results in decreased osteogenic potential. The combination of endocrine disorders including estrogen metabolism changes, vitamin D deficiency, and elevated parathyroid hormone levels makes bone defects worse while scientists continue to study melatonin, leptin and growth hormone potential roles. The combination of nutritional deficiencies that affect calcium, magnesium, zinc, and vitamin K2 levels in patients leads to increased metabolic risk. The combination of reduced physical activity, restricted bracing use, and impaired mechanotransduction leads to decreased skeletal loading which prevents adolescents from reaching their peak bone mass. Research evidence supports a complex system model which demonstrates scoliosis and low BMD share common genetic, hormonal, nutritional, and mechanical factors that affect spinal structure and complete skeletal health. The combination of genetic tests with endocrine, nutritional, and biomechanical evaluations will help doctors identify at-risk patients better while developing specific treatments to enhance bone strength and control spinal curve growth.