Risk factors for abnormal bone mineral density in Duchenne muscular dystrophy and the association of regular rehabilitation with bone health.

BACKGROUND: We investigated the prevalence and risk factors of abnormal bone mineral density (BMD) in Duchenne muscular dystrophy (DMD) and explored the potential association of regular rehabilitation with BMD. METHODS: A cross-sectional study including 215 boys with DMD was conducted. Multivariate logistic regression was used to identify independent predictors, and mediation analysis was performed to explore the pathway linking rehabilitation and BMD. RESULTS: Abnormal BMD was found in 62 patients (28.8%). Age was the strongest risk factor (adjusted OR = 1.0533 per month, 95%CI 1.0318-1.0752, P < 0.001), and regular rehabilitation was independently associated with a lower risk of abnormal BMD (adjusted OR = 0.2369, 95%CI 0.0935-0.6001, P = 0.002). The model showed good performance (Nagelkerke R 2 = 0.591, AUC = 0.906). Muscle function mediated 15.7% of the association. CONCLUSION: Regular rehabilitation was associated with 76.3% lower risk of abnormal BMD in DMD patients, suggesting a potential beneficial association. Age remained the predominant non-modifiable risk factor. Better muscle function partially mediated the favorable association between rehabilitation and BMD. These findings support integrating regular rehabilitation into routine care for DMD.