A new study published in The New England Journal of Medicine suggests that hand X-ray–derived measurements may help evaluate bone health in boys with Duchenne muscular dystrophy (DMD), offering a potential alternative when standard bone density scans are difficult to interpret.
Bone fragility is a major concern in DMD, and more than half of patients experience fractures at some point in their lives. Doctors typically rely on dual-energy X-ray absorptiometry (DXA) scans to measure bone mineral density, but scoliosis and spinal rods can make those scans difficult to read or less accurate.
Researchers explored whether two measurements taken from hand X-rays could help fill that gap: bone health index (BHI), which estimates bone strength by looking at the thickness of hand bones, and bone age, which compares skeletal maturity to expected age.
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The study included 41 boys and young men with DMD treated with daily deflazacort between 2017 and 2024. All participants had both a hand X-ray and a DXA scan done before the occurrence of any fractures.
Results showed that about one-third of participants had low BHI scores. The researchers found a moderate correlation between BHI and total body DXA results: Lower BHI tended to align with lower bone density on DXA. Bone age also showed a significant correlation with lumbar spine bone density.
More than half (56%) of study participants experienced fractures, most of them vertebral and silent, meaning the boys didn’t feel pain or notice symptoms.
While none of the hand X-ray measurements clearly predicted who experienced fractures, delayed bone age showed a possible trend toward higher fracture risk. Researchers say this relationship warrants further investigation with larger, long-term studies.
The researchers concluded that hand X-ray assessments represent a practical and noninvasive tool that could complement DXA in clinical care, especially when DXA interpretation is restricted. They caution that larger, prospective studies are needed before BHI or BA can be used reliably to predict fracture risk or guide bone health interventions in DMD.
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