title: Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes.
abstract: BACKGROUND
  Age at menarche is considered a reliable prognostic factor for idiopathic scoliosis and varies in different geographic latitudes. Adolescent idiopathic scoliosis prevalence has also been reported to be different in various latitudes and demonstrates higher values in northern countries. A study on epidemiological reports from the literature was conducted to investigate a possible association between prevalence of adolescent idiopathic scoliosis and age at menarche among normal girls in various geographic latitudes. An attempt is also made to implicate a possible role of melatonin in the above association.
  
  
  METHODS
  20 peer-reviewed published papers reporting adolescent idiopathic scoliosis prevalence and 33 peer-reviewed papers reporting age at menarche in normal girls from most geographic areas of the northern hemisphere were retrieved from the literature. The geographic latitude of each centre where a particular study was originated was documented. The statistical analysis included regression of the adolescent idiopathic scoliosis prevalence and age at menarche by latitude.
  
  
  RESULTS
  The regression of prevalence of adolescent idiopathic scoliosis and age at menarche by latitude is statistically significant (p < 0.001) and are following a parallel declining course of their regression curves, especially in latitudes northern than 25 degrees.
  
  
  CONCLUSIONS
  Late age at menarche is parallel with higher prevalence of adolescent idiopathic scoliosis. Pubarche appears later in girls that live in northern latitudes and thus prolongs the period of spine vulnerability while other pre-existing or aetiological factors are contributing to the development of adolescent idiopathic scoliosis. A possible role of geography in the pathogenesis of idiopathic scoliosis is discussed, as it appears that latitude which differentiates the sunlight influences melatonin secretion and modifies age at menarche, which is associated to the prevalence of idiopathic scoliosis.
authors.affiliation: Orthopaedic Department, "Thriasio" General Hospital, G, Gennimata Av, 19600, Magoula, Attica, Greece. grivastb@panafonet.gr
authors.forename: Theodoros B
authors.initials: TB
authors.lastname: Grivas
authors.forename: Elias
authors.initials: E
authors.lastname: Vasiliadis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Mouzakis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Mihas
authors.forename: Georgios
authors.initials: G
authors.lastname: Koufopoulos