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Endocrinol."],"abstract":"<jats:p>Duchenne muscular dystrophy (DMD) is a progressive, fatal muscle wasting disease caused by X-linked mutations in the dystrophin gene. Alongside the characteristic muscle weakness, patients face a myriad of skeletal complications, including osteoporosis\/osteopenia, high susceptibility to vertebral and long bone fractures, fat embolism post-fracture, scoliosis, and growth retardation. Those skeletal abnormalities significantly compromise quality of life and are sometimes life-threatening. These issues were traditionally attributed to loss of ambulation and chronic corticosteroid use, but recent investigations have unveiled a more intricate etiology. Factors such as vitamin D deficiency, hormonal imbalances, systemic inflammation, myokine release from dystrophic muscle, and vascular dysfunction are emerging as significant contributors as well. This expanded understanding illuminates the multifaceted pathogenesis underlying skeletal issues in DMD. Present therapeutic options are limited and lack specificity. Advancements in understanding the pathophysiology of bone complications in DMD will offer promising avenues for novel treatment modalities. In this review, we summarize the current understanding of factors contributing to bone problems in DMD and delineate contemporary and prospective multidisciplinary therapeutic approaches.<\/jats:p>","DOI":"10.3389\/fendo.2024.1398050","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T23:19:38Z","timestamp":1732749578000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Poor bone health in Duchenne muscular dystrophy: a multifactorial problem beyond corticosteroids and loss of ambulation"],"prefix":"10.3389","volume":"15","author":[{"given":"Amelia","family":"Hurley-Novatny","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhiro","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongshuai","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0333E","article-title":"Bone health and osteoporosis management of the patient with duchenne muscular dystrophy","volume":"142","author":"Ward","year":"2018","journal-title":"Pediatrics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30025-5","article-title":"Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management","volume":"17","author":"Birnkrant","year":"2018","journal-title":"Lancet Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.ejpn.2023.11.012","article-title":"Fat embolism syndrome in Duchenne muscular dystrophy: Report on a novel case and systematic literature review","volume":"48","author":"Specht","year":"2023","journal-title":"Eur J Paediatr Neurol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-003-1443-y","article-title":"Bone mineral density and bone metabolism in Duchenne muscular dystrophy","volume":"14","author":"Bianchi","year":"2003","journal-title":"Osteoporos Int"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1177\/0883073816650034","article-title":"Fracture in duchenne muscular dystrophy: natural history and vitamin D deficiency","volume":"31","author":"Perera","year":"2016","journal-title":"J Child Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"928385","DOI":"10.1155\/2015\/928385","article-title":"Optimizing bone health in duchenne muscular dystrophy","volume":"2015","author":"Buckner","year":"2015","journal-title":"Int J Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.410","article-title":"Mechanisms inducing low bone density in Duchenne muscular dystrophy in mice and humans","volume":"26","author":"Rufo","year":"2011","journal-title":"J Bone Miner Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/MED.0000000000000456","article-title":"Growth, pubertal development, and skeletal health in boys with Duchenne Muscular Dystrophy","volume":"26","author":"Ward","year":"2019","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S143317","article-title":"Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? 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