Genetics Meets Metabolism: Decoding Their Role in Idiopathic Scoliosis.

Adolescent Idiopathic Scoliosis (AIS) is increasingly recognized as a multisystem disorder arising from the interplay between genetic susceptibility, metabolic dysregulation, and impaired mechanobiological signaling. Recent genomic studies highlight defects in ciliary genes, implicating disrupted ciliary structure and signaling in altered spinal growth. Concurrently, metabolic disturbances including pubertal hormones, oxidative stress, and altered IGF-1 activity may exacerbate these genetic vulnerabilities by influencing bone remodeling and extracellular matrix properties. Epigenetic regulators such as microRNAs and endocrine factors such as melatonin further integrate metabolic cues with gene expression programs relevant to skeletal development. Together, these converging pathways disrupt primary cilia-dependent mechanotransduction, leading to asymmetric vertebral growth during puberty. This integrated framework positions AIS as a systemic condition and highlights new opportunities for biomarker discovery and better understanding of AIS pathogenesis.