source: Scottish Muscle Network
This guideline is based on consensus between paediatricians managing children with neuromuscular disorders and paediatric endocrinologists with interests in bone disorders.
The aim of this guideline is to maintain health, mobility and function as much as possible, by promoting bone health, and treating those with pathological fractures.
Bone Health Monitoring
Before starting steroids and annually
• Blood Test:
Bone profile (Calcium, Phosphate), Alkaline phosphatase, 25 hydroxy vitamin D and Parathyroid hormones (PTH)
• DXA scan
• Lateral thoracolumbar spine x-ray: Performed when starting steroids.
Consider repeating at regular intervals (e.g., every two years).
Perform if there is back pain, absent growth, loss of height regardless of previous investigations.
In centres with the new iDXA scanner, assessment of vertebral morphology using DXA images (DXA lateral vertebral morphometry) may be equivalent to spine x-rays for detection of vertebral compression abnormalities.