Risk factors associated with prevalent vertebral fractures in Duchenne muscular dystrophy

Growth hormone and testosterone delay vertebral fractures in boys with muscular dystrophy on chronic glucocorticoids

“…77% of the cohort sustained VFs during the observation period, mostly concentrated in T11, T12, and L1, highlighting extreme skeletal fragility of especially the lower vertebrae that sustain the weight of the upper vertebrae. Relative to prior studies, we found a similar prevalence of osteoporosis [ 4 ] and pattern of VFs [ 21 ], However, this study extends previous results by including a longer observation period of interventions and collection of additional clinical information for multiple regression analyses.…”

“…We analyzed SDI when on distinct endocrine interventions. A previous study highlighted that GCs place patients with DMD at an extremely high risk of sustaining VFs, with the lower spine being more likely to sustain more severe VFs [ 21 ]. Another study found that oral bisphosphonates did not increase the prevalence or severity of VFs for participants who already sustained a VF [ 27 ].…”

“…However, older age and loss of ambulation, with lower fall risk, appeared to be protective. Prior studies have suggested that older age and loss of ambulation was associated with increased risk of fracture [ 48 ], while more recent studies have reported either no difference or decreased incidence of fracture, likely related to reduced fall risk and changes in the mechanical loading patterns to the spine [ 21 , 49 ]. These conflicting views may be due to the age of the cohorts studied and differences in timing of the fracture.…”

“…These conflicting views may be due to the age of the cohorts studied and differences in timing of the fracture. For example, patients can sustain a fracture and consequently lose ambulation [ 21 ]. On the contrary, loss of skeletal mass from decreased mechanical loading with loss of ambulation may increase fracture risk.…”

Moving Beyond the 2018 Minimum International Care Considerations for Osteoporosis Management in Duchenne Muscular Dystrophy (DMD): Meeting Report from the 3rd International Muscle-Bone Interactions Meeting 7th and 14th November 2022

“…Dr. Kim Phung (Ottawa, Canada) presented her data assessing risk factors for and predictors of vertebral fractures in DMD [ 76 ]. In this group’s 12-month prospective bi-centre study of 60 glucocorticoid-treated males with DMD aged 4–25 years, they showed that 19/60 (32%) of patients had at least one prevalent vertebral fracture at baseline (after an average of 4.5 years of GC exposure) [ 76 ].…”