A recent article published in Frontiers in Endocrinology discussed that neuromuscular diseases (NMDs) are inherited or acquired conditions affecting the skeletal muscles, motor nerves or neuromuscular junctions. Majority of NMDs are characterized by a progressive damage of muscle fibers with reduced muscle strength, disability and poor health-related quality of life of affected patients. Thus, skeletal health is usually compromised as a consequence of modified bone-muscle cross-interaction, including the biomechanical and bio-humoral issues, resulting in an increased risk for bone fragility and fractures. While NMD patients often face nutritional issues, including malnutrition due to feeding disorders and swallowing problems, that could affect their bone health. Besides, in these patients, low levels of physical activity or immobility are common—predisposing to an increased risk for overweight or obesity that can also interfere with the bone strength.

The authors reported that vitamin D deficiency also plays a critical role in the pathogenesis and clinical scenario of many NMDs – its supplementation could be useful in maintaining or enhancing bone health, especially in the early phases of NMDs. However, specific disease-modifying drugs, available for some NMDs can cause adverse effects on bone tissue. One such example is glucocorticoid therapy – a standard of care for many muscular dystrophies, that prolongs long-term survival, but higher doses and/or chronic use can result in secondary osteoporosis.

The article summarized that considering the complexity of care of NMD patients, an interdisciplinary and multimodal management strategy based on both, pharmacological and non-pharmacological interventions is necessary, which targets musculoskeletal issues closely linked to functional independence as well as social implications.

Source: Iolascon G, Paoletta M, Liguori S, Curci C, Moretti A. Neuromuscular Diseases and Bone. Front Endocrinol (Lausanne). 2019;10:794. Published 2019 Nov 22. doi:10.3389/fendo.2019.00794