20–60% of boys with DMD have low-trauma extremity fractures, suggesting osteoporosis

Muscle weakness has a progressive detrimental effect on bone health, which can be exacerbated by glucocorticoid use

• Patients with DMD are therefore at risk of osteoporosis
• 2018 guidelines recommend asymptomatic vertebral fractures screening
• Previous guidance relied on bone density scores and the presence of symptomatic fractures

In case of osteoporosis, patients should be treated by a specialist

• Intravenous bisphosphonates are indicated to preserve the height of vertebral bodies/prevent spine fractures

The aims of musculoskeletal care are to maintain motor function, minimise joint contractures, maintain a straight spine and promote bone health

• Assessments

  • Range of motion assessed every 6 months
  • Spine straightness every year (6 months for non-ambulatory patients)

• Interventions

  • Home stretching programme focused on ankles, knees and hips
  • Fracture prevention guidance for families
  • Ankle-foot orthoses (in some patients)

Refer to a surgeon if spinal curvature exceeds 20˚