Muscle function and age are associated with loss of bone mineral density in Duchenne muscular dystrophy

Cruz-Guzmán, Oriana del Rocío; Rodríguez‐Cruz, Maricela; Almeida-Becerril, Tomas; Maldonado-Hernández, Jorge; Baeza, Carlos Wong

doi:10.1002/mus.26416

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…Therefore, when there is a decrease in muscle use, bone loss occurs [9,34]. Studies have shown that decreased muscle function and aging directly contribute to decreased bone density in patients with DMD [11], which is consistent with our results.…”

Section: Discussionsupporting

confidence: 92%

“…The damage to muscle bers present in DMD patients is related to chronic in ammation of the muscles and the release of in ammatory cytokines, which impair the function of the cells involved in the formation of bone tissue. This damage can be a contributing factor to bone loss in DMD patients [11].…”

Section: Discussionmentioning

confidence: 99%

“…Most of studies on bone density in DMD patients did not divide the study participants by age, a factor that may be associated with bone mineral density. Furthermore, most of studies investigating the relationship between age and BMD in patients with this dystrophy analyzed the spine region or the total body exclusively [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Duchenne Muscular Dystrophy and Bone Mineral Density

Lima

Grilo

Cunha

et al. 2021

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Duchenne muscular dystrophy (DMD) patients are at risk of developing conditions that can compromise their bone health, such as fractures and walking impairment. We aimed to assess bone mineral density as a function of the age of DMD patients. The cross-sectional study included 48 patients distributed into four groups by age: G1 (5.1-9.2 years), G2 (9.3-10.7 years), G3 (11.2-15.9 years), and G4 (18-24.7 years). Lumbar spine and total body bone mineral density (BMD) measurements were performed with dual-energy X-ray absorptiometry. There was a moderate negative correlation between age and the lumbar spine BMD z-score (p = 0.001; r = -0.45) and a strong negative correlation between age and the total body BMD z-score (p = 0.001; r = -0.79). The lumbar spine BMD z-scores in G3 and G4 were significantly lower than those in G1 and G2 (p < 0.05). The total body BMD z-score in G3 was lower than those in G1 and G2 (p < 0.05), and in G4 was lower than those in the other groups (p < 0.05). Conclusion: The older patients had lower lumbar spine and total body BMD z-score values than younger patients. Moreover, these values were negatively correlated with the age of the patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Duchenne Muscular Dystrophy and Bone Mineral Density

Lima

Grilo

Cunha

et al. 2021

Preprint

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“…In our study, an association between FMS and BMD Z score was observed in multilevel mixed-effects model analysis (β=-0.454, p=0.031). A previous study also observed that a Vignos scale ≥6 for lower extremity function can predict BMD loss ( 30 ). Progressive decline in muscle function with age is frequently accompanied by a decline in BMD and bone quality, leading to increased bone fragility fractures ( 13 ).…”

Section: Discussionmentioning

confidence: 77%

“…Age might be useful for estimating the risk of lumbar BMD loss in boys with DMD. A previous study noted that age ≥10.5 years was associated with a reduction in BMD in boys with DMD ( 30 ). Summer et al.…”

Section: Discussionmentioning

confidence: 97%

Bone Mineral Density Assessment by Quantitative Computed Tomography in Glucocorticoid-Treated Boys With Duchenne Muscular Dystrophy: A Linear Mixed-Effects Modeling Approach

et al. 2022

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ObjectiveBoys with Duchenne muscular dystrophy (DMD) are at risk of bone damage and low bone mineral density (BMD). The aim of the study is to examine lumbar BMD values measured by QCT and identify the factors associated with BMD loss using a multilevel mixed-effects model.MethodsLumbar BMD was evaluated by quantitative computed tomography (QCT) at diagnosis, 1 and 2 years follow up in patients with DMD who were treated with GC. Demographic data, functional activity scores (FMSs), laboratory parameters and steroid use were recorded. A multilevel mixed-effects model was used to analyze BMD loss.ResultsNineteen patients with DMD who had a total of sixty complete records between January 2018 and October 2021 were retrospectively analyzed. At baseline, 15.8% of patients (3/19) had low lumbar BMD (Z score ≤ −2), and the mean BMD Z score on QCT was -0.85 (SD 1.32). The mean BMD Z score at 1 and 2 years postbaseline decreased to -1.56 (SD 1.62) and -2.02 (SD 1.36), respectively. In our model, BMD Z score loss was associated with age (β=-0.358, p=0.0003) and FMS (β=-0.454, p=0.031). Cumulative GC exposure and serum levels of calcium, phosphorus, 25(OH)-vitamin D and creatinine kinase did not independently predict BMD loss.ConclusionsThis study demonstrates that in DMD patients, lumbar BMD decreased gradually and progressively. Age and FMS are the main contributors to BMD loss in boys with DMD. Early recognition of risk factors associated with BMD loss may facilitate the development of strategies to optimize bone health.

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Low‐Intensity Vibration Protects the Weight‐Bearing Skeleton and Suppresses Fracture Incidence in Boys With Duchenne Muscular Dystrophy: A Prospective, Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial

et al. 2022

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The ability of low-intensity vibration (LIV) to combat skeletal decline in Duchenne Muscular Dystrophy (DMD) was evaluated in a randomized controlled trial. Twenty DMD boys were enrolled, all ambulant and treated with glucocorticoids (mean age 7.6, heightadjusted Z-scores [HAZ] of hip bone mineral density [BMD] À2.3). Ten DMD boys were assigned to stand for 10 min/d on an active LIV platform (0.4 g at 30 Hz), while 10 stood on a placebo device. Baseline and 14-month bone mineral content (BMC) and BMD of spine, hip, and total body were measured with DXA, and trabecular bone density (TBD) of tibia with quantitative computed tomography (QCT). All children tolerated the LIV intervention well, with daily compliance averaging 78%. At 14 months, TBD in the proximal and distal tibia remained unchanged in placebo subjects (À1.0% and À0.2%), while rising 3.5% and 4.6% in LIV subjects. HAZ for hip BMD and BMC in the placebo group declined 22% and 13%, respectively, contrasting with no change from baseline (0.9% and 1.4%) in the LIV group. Fat mass in the leg increased 32% in the placebo group, contrasting with 21% in LIV subjects. Across the 14-month study, there were four incident fractures in three placebo patients (30%), with no new fractures identified in LIV subjects. Despite these encouraging results, a major limitation of the study is-despite randomized enrollment-that there was a significant difference in age between the two cohorts, with the LIV group being 2.8y older, and thus at greater severity of disease. In sum, these data suggest that noninvasive LIV can help protect the skeleton of DMD children against the disease progression, the consequences of diminished load bearing, and the complications of chronic steroid use.

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Muscle function and age are associated with loss of bone mineral density in Duchenne muscular dystrophy

Cited by 11 publications

References 31 publications

Duchenne Muscular Dystrophy and Bone Mineral Density

Duchenne Muscular Dystrophy and Bone Mineral Density

Bone Mineral Density Assessment by Quantitative Computed Tomography in Glucocorticoid-Treated Boys With Duchenne Muscular Dystrophy: A Linear Mixed-Effects Modeling Approach

Low‐Intensity Vibration Protects the Weight‐Bearing Skeleton and Suppresses Fracture Incidence in Boys With Duchenne Muscular Dystrophy: A Prospective, Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial

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