Background
Fractures are a source of morbidity in boys with Duchenne muscular dystrophy (DMD) and can lead to loss-of-ambulation, significantly impacting quality of life and independence. Risk factors for fractures include chronic supraphysiologic glucocorticoid exposure, progressive muscle weakness, reduced bone mineral density and excess adiposity. Our goal is to identify modifiable factors in our multidisciplinary clinic to prevent fracture recurrence.
Objectives
To review recent fracture events in boys with DMD and identify common clinical features with the goal of optimizing bone health management and preventing fracture recurrence.
Methods
We conducted a retrospective chart review of boys with DMD followed in a multidisciplinary neuromuscular clinic at a single academic children’s hospital who sustained one or more fractures within the preceding year (January-December 2025). Data collected included age, DMD genotype, ambulation status, 10-meter walk/run test, glucocorticoid regimen plus any disease modifying therapy, fracture type, vitamin D status, bone density scan results and use/timing of bisphosphonate therapy.
Results
We identified four patients with DMD (ages 11–16 years) who sustained fractures during the study period. All patients were ambulatory at the time of fracture and on daily glucocorticoid therapy. Two patients had initiated bisphosphonate therapy within the year prior to fracture, while the others had not started. Frequency of bone density screening using DXA varied but all had evidence of low bone density at one or more sites. All patients were taking vitamin D and most had levels >30 ng/mL. Given the small sample size, no definitive conclusions could be drawn.
Conclusions
In this cohort, fractures occurred exclusively in ambulatory boys with DMD, many of whom had not yet received or had only recently initiated bisphosphonate therapy despite having evidence of low bone density. These findings highlight the need for proactive bone health surveillance and suggest that consideration of bisphosphonates once BMD Z-scores ≤ −2.0 and/or significant annual BMD decline—prior to first fracture—may represent a critical opportunity for fracture prevention during the ambulatory phase.