{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:49:14Z","timestamp":1791614954810,"version":"4.3.4"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:00:00Z","timestamp":1675814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: Neuromuscular Diseases (NMD) are associated with decreased bone strength due to altered muscle\u2013bone interaction. However, the evaluation of bone quality remains a certain challenge in these patients. The purpose of this scoping review is to investigate the recent literature regarding the assessment of Bone Mineral Density (BMD) in this population. Methods: An electronic search of the PubMed and Scopus database was performed considering studies published in the English literature after 2007 that evaluated BMD in pediatric and adolescent patients with NMD. We excluded studies that evaluated patients &gt; 20 years, studies not involving humans, and studies investigating bone mineral density in various pediatric conditions, but without specific data on NMD. Results: Overall, 19 studies were included that evaluated BMD in 1983 patients with NMD. Duchenne Muscular Dystrophy was the most widely studied disease (n = 11 studies). Dual energy X-ray absorptiometry (DEXA) was the most common diagnostic modality for BMD evaluation, while the most frequent site for BMD measurement was the lumbar spine (89.4%, n = 17 studies), followed by total body BMD (68.4%, n = 13 studies). Low BMD in children with NMD was demonstrated in all studies, especially after loss of ambulation. Moreover, a positive correlation between lower BMD and older age was shown. Conclusions: BMD evaluation in NMD remains a clinical challenge, as indicated by the high heterogeneity regarding the optimal site and technique for the evaluation of bone quality in these patients. Although DXA is currently the diagnostic modality of choice, a consensus regarding the optimal site for BMD measurement, and the adjustment method for its obtained measurements for parameters such as age and height is needed.<\/jats:p>","DOI":"10.3390\/medicina59020312","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T03:01:45Z","timestamp":1675825305000},"page":"312","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Scoping Review of the Recent Clinical Practice Regarding the Evaluation of Bone Mineral Density in Children and Adolescents with Neuromuscular Diseases"],"prefix":"10.3390","volume":"59","author":[{"given":"Georgia","family":"Antoniou","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, \u201cNicosia\u201d General Hospital, 2029 Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Masouros","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, \u201cEvaggelismos\u201d General Hospital, 10676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios V.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Orthopaedic Surgery, \u201cKonstantopouleio\u201d General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos C.","family":"Soultanis","sequence":"additional","affiliation":[{"name":"1st Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Krallis","sequence":"additional","affiliation":[{"name":"2nd Department of Orthopedic Surgery, \u201cAgia Sofia\u201d General Children\u2019s Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-7314","authenticated-orcid":false,"given":"George","family":"Babis","sequence":"additional","affiliation":[{"name":"2nd Department of Orthopaedic Surgery, \u201cKonstantopouleio\u201d General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7422-4195","authenticated-orcid":false,"given":"Vasileios S.","family":"Nikolaou","sequence":"additional","affiliation":[{"name":"2nd Department of Orthopaedic Surgery, \u201cKonstantopouleio\u201d General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.1007\/s00467-010-1517-y","article-title":"Analyses of muscular mass and function: The impact on bone mineral density and peak muscle mass","volume":"25","author":"Fricke","year":"2010","journal-title":"Pediatr. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s11914-017-0396-6","article-title":"Muscle-Bone Interactions in Pediatric Bone Diseases","volume":"15","author":"Veilleux","year":"2017","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_3","first-page":"154","article-title":"Perspective: Cerebral palsy as a model of bone development in the absence of postnatal mechanical factors","volume":"6","author":"Ward","year":"2006","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.jocd.2014.01.004","article-title":"Fracture prediction and the definition of osteoporosis in children and adolescents: The ISCD 2013 Pediatric Official Positions","volume":"17","author":"Bishop","year":"2014","journal-title":"J. Clin. Densitom."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jocd.2007.12.005","article-title":"Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: The 2007 ISCD Pediatric Official Positions","volume":"11","author":"Gordon","year":"2008","journal-title":"J. Clin. Densitom."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1385\/JCD:8:3:298","article-title":"Reproducibility of pediatric whole body bone and body composition measures by dual-energy X-ray absorptiometry using the GE Lunar Prodigy","volume":"8","author":"Margulies","year":"2005","journal-title":"J. Clin. Densitom."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.nmd.2007.05.008","article-title":"Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy","volume":"17","author":"Soderpalm","year":"2007","journal-title":"Neuromuscul. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jpeds.2009.09.010","article-title":"Regional changes in bone area and bone mineral content in boys with duchenne muscular dystrophy receiving corticosteroid therapy","volume":"156","author":"Crabtree","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.nmd.2012.06.354","article-title":"Bone health in boys with Duchenne Muscular Dystrophy on long-term daily deflazacort therapy","volume":"22","author":"Mayo","year":"2012","journal-title":"Neuromuscul. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/mus.23963","article-title":"Skeletal health in Duchenne dystrophy: Bone-size and subcranial dual-energy X-ray absorptiometry analyses","volume":"49","author":"King","year":"2014","journal-title":"Muscle Nerve"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s13760-015-0582-1","article-title":"Body composition of patients with Duchenne muscular dystrophy: The Greek experience","volume":"116","author":"Doulgeraki","year":"2016","journal-title":"Acta Neurol. Belg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.nmd.2016.08.011","article-title":"Bone health measures in glucocorticoid-treated ambulatory boys with Duchenne muscular dystrophy","volume":"26","author":"Tian","year":"2016","journal-title":"Neuromuscul. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00198-016-3774-5","article-title":"The time to and determinants of first fractures in boys with Duchenne muscular dystrophy","volume":"28","author":"Ma","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bone.2018.07.019","article-title":"Growth, bone health & ambulatory status of boys with DMD treated with daily vs. intermittent oral glucocorticoid regimen","volume":"116","author":"Crabtree","year":"2018","journal-title":"Bone"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/BPO.0000000000000817","article-title":"Vertebral Fractures in Duchenne Muscular Dystrophy Patients Managed With Deflazacort","volume":"38","author":"Singh","year":"2018","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.nmd.2018.09.005","article-title":"Fractures and bone health monitoring in boys with Duchenne muscular dystrophy managed within the Scottish Muscle Network","volume":"29","author":"Joseph","year":"2019","journal-title":"Neuromuscul. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.2217\/cer-2019-0170","article-title":"Real-world outcomes of long-term prednisone and deflazacort use in patients with Duchenne muscular dystrophy: Experience at a single, large care center","volume":"9","author":"Marden","year":"2020","journal-title":"J. Comp. Eff. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.nmd.2012.04.008","article-title":"Observational study of caloric and nutrient intake, bone density, and body composition in infants and children with spinal muscular atrophy type I","volume":"22","author":"Poruk","year":"2012","journal-title":"Neuromuscul. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.bone.2015.05.039","article-title":"Bone and Spinal Muscular Atrophy","volume":"79","author":"Vai","year":"2015","journal-title":"Bone"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.nmd.2017.01.019","article-title":"Low bone mineral density and fractures are highly prevalent in pediatric patients with spinal muscular atrophy regardless of disease severity","volume":"27","author":"Wasserman","year":"2017","journal-title":"Neuromuscul. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.nmd.2019.06.001","article-title":"Evolution of bone mineral density, bone metabolism and fragility fractures in Spinal Muscular Atrophy (SMA) types 2 and 3","volume":"29","author":"Baranello","year":"2019","journal-title":"Neuromuscul. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/CND.0b013e318183e0fa","article-title":"Low bone mineral density in spinal muscular atrophy","volume":"10","author":"Khatri","year":"2008","journal-title":"J. Clin. Neuromuscul. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1359\/jbmr.091007","article-title":"The relationship between fractures and DXA measures of BMD in the distal femur of children and adolescents with cerebral palsy or muscular dystrophy","volume":"25","author":"Henderson","year":"2010","journal-title":"J. Bone Miner. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/j.1651-2227.2011.02532.x","article-title":"Bone mass development in patients with Duchenne and Becker muscular dystrophies: A 4-year clinical follow-up","volume":"101","author":"Soderpalm","year":"2012","journal-title":"Acta Paediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1055\/s-0035-1563695","article-title":"Differential Analysis of Bone Density in Children and Adolescents with Neuromuscular Disorders and Cerebral Palsy","volume":"46","author":"Razmdjou","year":"2015","journal-title":"Neuropediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.bone.2004.01.001","article-title":"Relationship between the duration of paralysis and bone structure: A pQCT study of spinal cord injured individuals","volume":"34","author":"Eser","year":"2004","journal-title":"Bone"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S8756-3282(03)00062-0","article-title":"Peak spine and femoral neck bone mass in young women","volume":"32","author":"Lin","year":"2003","journal-title":"Bone"},{"key":"ref_28","first-page":"CD010899","article-title":"Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy","volume":"1","author":"Bell","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1002\/ar.a.20224","article-title":"Muscle-bone interactions in dystrophin-deficient and myostatin-deficient mice","volume":"286","author":"Montgomery","year":"2005","journal-title":"Anat. Rec. Part A Discov. Mol. Cell. Evol. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/01241398-200001000-00016","article-title":"Bone mineral density and fractures in boys with Duchenne muscular dystrophy","volume":"20","author":"Larson","year":"2000","journal-title":"J. Pediatr. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"794","DOI":"10.3389\/fendo.2019.00794","article-title":"Neuromuscular Diseases and Bone","volume":"10","author":"Iolascon","year":"2019","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jocd.2019.07.002","article-title":"The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position","volume":"22","author":"Weber","year":"2019","journal-title":"J. Clin. Densitom."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3160","DOI":"10.1210\/jc.2011-1111","article-title":"Revised reference curves for bone mineral content and areal bone mineral density according to age and sex for black and non-black children: Results of the bone mineral density in childhood study","volume":"96","author":"Zemel","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_34","first-page":"73","article-title":"The mechanostat: A proposed pathogenic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents","volume":"2","author":"Frost","year":"1987","journal-title":"Bone Miner."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.nmd.2004.10.011","article-title":"Taking steps towards reducing osteoporosis in Duchenne muscular dystrophy","volume":"15","author":"Bachrach","year":"2005","journal-title":"Neuromuscul. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jocd.2014.01.003","article-title":"Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: The revised 2013 ISCD Pediatric Official Positions","volume":"17","author":"Crabtree","year":"2014","journal-title":"J. Clin. Densitom."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1210\/jc.2014-3096","article-title":"The choice of normative pediatric reference database changes spine bone mineral density Z-scores but not the relationship between bone mineral density and prevalent vertebral fractures","volume":"100","author":"Ma","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jocd.2014.01.006","article-title":"Quantitative computer tomography in children and adolescents: The 2013 ISCD Pediatric Official Positions","volume":"17","author":"Adams","year":"2014","journal-title":"J. Clin. Densitom."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s00198-010-1275-5","article-title":"Low bone density and bone metabolism alterations in Duchenne muscular dystrophy: Response to calcium and vitamin D treatment","volume":"22","author":"Bianchi","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1359\/jbmr.040902","article-title":"Epidemiology of childhood fractures in Britain: A study using the general practice research database","volume":"19","author":"Cooper","year":"2004","journal-title":"J. Bone Miner. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/01.bpo.0000235228.45539.c7","article-title":"Fractures in children with cerebral palsy","volume":"26","author":"Leet","year":"2006","journal-title":"J. Pediatr. Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","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":"ref_43","doi-asserted-by":"crossref","first-page":"3408","DOI":"10.1210\/JC.2015-2176","article-title":"Incident Vertebral Fractures in Children With Leukemia During the Four Years Following Diagnosis","volume":"100","author":"Cummings","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1002\/jbmr.2511","article-title":"Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders","volume":"30","author":"LeBlanc","year":"2015","journal-title":"J. Bone Miner. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/312\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:27:46Z","timestamp":1760120866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,8]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["medicina59020312"],"URL":"https:\/\/doi.org\/10.3390\/medicina59020312","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,8]]}}}