Risk Factors Associated with Incident Vertebral Fractures in Steroid-treated Males with Duchenne Muscular Dystrophy

J Clin Endocrinol Metab. 2024 Jan 18;109(2):536-548. doi: 10.1210/clinem/dgad435.


Purpose: Prevention of fractures is an unmet need in glucocorticoid (GC)-treated Duchenne muscular dystrophy. This study explored factors associated with incident vertebral fractures (VFs) to inform future fracture prevention efforts.

Methods: VFs were evaluated prospectively at study baseline and 12 months on lateral spine radiographs in participants aged 4 to 25 years with Duchenne muscular dystrophy. Clinical factors were analyzed for their association with the change in Spinal Deformity Index (sum of the Genant-defined VF grades from T4 to L4) between baseline and 12 months.

Results: Thirty-eight males were evaluated (mean ± SD age at baseline 11.0 ± 3.6 years; mean ± SD GC duration at baseline 4.1 ± 3.1 years; 74% ambulatory). Nine of 38 participants (24%) had 17 incident VFs, of which 3/17 VFs (18%) were moderate/severe. Participants with 12-month incident VF had lower mean ± SD baseline lumbar spine areal bone mineral density Z-scores (-2.9 ± 1.0 vs -1.9 ± 1.1; P = .049) and lower total body less head areal bone mineral density Z-scores (-3.1 ± 1.2 vs -1.6 ± 1.7; P = .036). Multivariable linear regression showed that at least 1 VF at baseline (P < .001), a higher number of antecedent non-VF (P < .001), and greater bone age delay at baseline (P = .027) were significant predictors of an increase in the Spinal Deformity Index from baseline to 12 months.

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.

Keywords: Duchenne muscular dystrophy; bone fragility; glucocorticoids; incident fractures; osteoporosis; vertebral fractures.

MeSH terms

  • Bone Density
  • Fractures, Bone* / chemically induced
  • Fractures, Bone* / etiology
  • Glucocorticoids / adverse effects
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Muscular Dystrophy, Duchenne* / complications
  • Muscular Dystrophy, Duchenne* / drug therapy
  • Muscular Dystrophy, Duchenne* / epidemiology
  • Osteoporotic Fractures* / etiology
  • Risk Factors
  • Spinal Fractures* / diagnostic imaging
  • Spinal Fractures* / epidemiology
  • Spinal Fractures* / etiology
  • Steroids


  • Glucocorticoids
  • Steroids