Steroids prolong walking in Duchenne MS

NEW YORK, May 10 (Reuters) Boys with Duchenne muscular dystrophy, the most common type of muscular dystrophy, who are treated with long-term steroid therapy are able to walk on their own for several more years than boys not treated with steroids, according to findings published in the May issue of Neurology. However, this benefit comes at the cost of more fractures.

Duchenne muscular dystrophy ''is rapidly progressive, with most boys losing the ability to walk between ages 9 and 11,'' write Dr J T Kissel and colleagues from Ohio State University, Columbus.

In their study, the researchers examined the effects off long-term daily corticosteroid treatment on a number of orthopedic outcomes in boys with Duchenne muscular dystrophy. Of 159 charts that were reviewed, 143 were included in the group (16 patients with Becker dystrophy were excluded.) Seventy-five patients (52.4 per cent) had been treated with daily steroids for at least 1 year (average duration 8 years). Sixty-eight boys (47.6 per cent) had never received steroid treatment or they had been treated for less than 6 months.

Independent walking stopped after an average age of 9.21 years in the untreated group, compared with 12.52 years in the steroid-treated group, a statistically significant difference.

The investigators found that 91 per cent of untreated boys and 31 per cent of treated boys had scoliosis (curvature of the spine), and 29 per cent and 15 per cent of the untreated and treated subjects, respectively, had undergone scoliosis surgery. The mean degree of scoliosis was 33.15 degrees for the untreated group and 11.58 degrees for the treated group.

However, 38.7 percent of steroid-treated patients had long-bone fractures, compared with 26.5 per cent of untreated patients. No vertebral compression fractures were observed in the untreated group, whereas vertebral compression fractures occurred in 32 per cent of the treated group.

''Because of the orthopedic implications of steroid therapy in this population, aggressive prophylactic measures are indicated as soon is therapy as initiated,'' Kissel's team stresses. Whether bisphosphonate drugs to strengthen bones, such as Actonel, have a role in preventing osteoporosis in this setting ''remains to be determined.'' Reuters SV DB0911