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. 2017 Jan 24;1(1):CD010899.
doi: 10.1002/14651858.CD010899.pub2.

Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy

Jennifer M Bell  1 , Michael D Shields  1 , Janet Watters  2 , Alistair Hamilton  3 , Timothy Beringer  4 , Mark Elliott  5 , Rosaline Quinlivan  6 , Sandya Tirupathi  7 , Bronagh Blackwood  1
Affiliations

Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy

Jennifer M Bell et al. Cochrane Database Syst Rev. .

Abstract

Background: Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD.

Objectives: To assess the effects of interventions to prevent or treat osteoporosis in children and adults with DMD taking long-term corticosteroids; to assess the effects of these interventions on the frequency of vertebral fragility fractures and long-bone fractures, and on quality of life; and to assess adverse events.

Search methods: On 12 September 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus to identify potentially eligible trials. We also searched the Web of Science ISI Proceedings (2001 to September 2016) and three clinical trials registries to identify unpublished studies and ongoing trials. We contacted correspondence authors of the included studies in the review to obtain information on unpublished studies or work in progress.

Selection criteria: We considered for inclusion in the review randomised controlled trials (RCTs) and quasi-RCTs involving any bone health intervention for corticosteroid-induced osteoporosis and fragility fractures in children, adolescents, and adults with a confirmed diagnosis of DMD. The interventions might have included oral and intravenous bisphosphonates, vitamin D supplements, calcium supplements, dietary calcium, testosterone, and weight-bearing activity.

Data collection and analysis: Two review authors independently assessed reports and selected potential studies for inclusion, following standard Cochrane methodology. We contacted study authors to obtain further information for clarification on published work, unpublished studies, and work in progress.

Main results: We identified 18 potential studies, of which two, currently reported only as abstracts, met the inclusion criteria for this review. Too little information was available for us to present full results or adequately assess risk of bias. The participants were children aged five to 15 years with DMD, ambulant and non-ambulant. The interventions were risedronate versus no treatment in one trial (13 participants) and whole-body vibration versus a placebo device in the second (21 participants). Both studies reported improved bone mineral density with the active treatments, with no improvement in the control groups, but the abstracts did not compare treatment and control conditions. All children tolerated whole-body vibration treatment. No study provided information on adverse events. Two studies are ongoing: one investigating whole-body vibration, the other investigating zoledronic acid.

Authors' conclusions: We know of no high-quality evidence from RCTs to guide use of treatments to prevent or treat corticosteroid-induced osteoporosis and reduce the risk of fragility fractures in children and adults with DMD; only limited results from two trials reported in abstracts were available. We await formal trial reports. Findings from two ongoing relevant studies and two trials, for which only abstracts are available, will be important in future updates of this review.

PubMed Disclaimer

Conflict of interest statement

JMB: none known TB: acknowledges financial support received from Servier Laboratories Ltd and Amgen UK Ltd to attend national conferences and payment with respect to chairman and speakers fees. BB: none known ME: none known AH: none known RQ: is Joint Co‐ordinating Editor of Cochrane Neuromuscular and is the author of two consensus workshop reports for bone health in Duchenne muscular dystrophy. Dr Quinlivan has received an honorarium from Genzyme for lecturing on metabolic muscle disease, as well as consultancy fees from Novartis and Guidepoint Global. MDS: has received honoraria from GlaxoSmithKline, AstraZeneca, Novartis, Merck Sharp & Dohme, and ALK‐Abelló for lectures given at educational meetings and received hospitality to attend the European Respiratory Society and British Thoracic Society annual meetings. ST: none known JW: a member of charities Action Duchenne and the Muscular Dystrophy UK.

Figures

1
1
A flow diagram illustrating the study selection process.
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study. Green = low risk of bias; yellow = unclear risk of bias; red (not shown) = high risk of bias.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010899

References

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References to other published versions of this review

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