Risk Factors Associated with Incident Vertebral Fractures in Steroid-treated Males with Duchenne Muscular Dystrophy
Authors' conclusion
The observation that ≥ 1 prevalent VF and/or non-VF were the strongest predictors of incident VFs at 12 months supports the need for prevention of first fractures in this high-risk setting. Bone age delay, a marker of GC exposure, may assist in the prioritization of patients in efforts to prevent first fractures.
Study context
- Population
- Glucocorticoid (GC)-treated males aged 4 to 25 years with Duchenne muscular dystrophy; mean ± SD age 11.0 ± 3.6 years, GC duration 4.1 ± 3.1 years, 74% ambulatory
- Participants
- 38 males
- Exposure
- Participants with vs without 12-month incident VF
- Incident VFn = 9
- Outcome
- Change in Spinal Deformity Index (sum of Genant-defined VF grades T4–L4); clinical factors associated
- Follow-up
- Baseline to 12 months
Main finding
As reported in the abstract
Incident VFs · 12 months
- Participants with incident vertebral fractures (VFs)
- 9 of 38 (24%)
- Incident VFs
- 17
- Moderate/severe VFs
- 3/17 (18%)
- ≥1 VF at baseline predicted increase in Spinal Deformity Index (multivariable linear regression)
- P < .001
- Higher number of antecedent non-VF predicted increase in Spinal Deformity Index
- P < .001
- Greater bone age delay at baseline predicted increase in Spinal Deformity Index
- P = .027
Observational data: associations, not effects.
Further findings
Mean
| Outcome | Incident VF | No incident VF | P value |
|---|---|---|---|
| Baseline lumbar spine areal BMD Z-scoreLower with incident VF | −2.9 (SD 1.0) | −1.9 (SD 1.1) | P = 0.049 |
| Baseline total body less head areal BMD Z-scoreLower with incident VF | −3.1 (SD 1.2) | −1.6 (SD 1.7) | P = 0.036 |
Original publication
Risk Factors Associated with Incident Vertebral Fractures in Steroid-treated Males with Duchenne Muscular Dystrophy. J Clin Endocrinol Metab. Published 23 August 2023. doi:10.
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