Challenge of the Week / Spine / 12.13.19

A 5-year-old male presents for walking abnormalities. His parents observe that he is walking on his toes and his calves have become larger over the past 6 months. His serum creatine phosphokinase (CPK) level is 100 times the normal value. DNA testing confirms Duchenne muscular dystrophy (DMD). Further workup reveals hyperlordosis and scoliosis with a curve measuring 20°. Which of the following categories of medications is effective for preventing scoliosis curve progression?
  • Bisphosphonates
  • Bisphosphonates inhibit osteoclasts and are the first-line of treatment for patients with osteoporosis.

  • Antibiotics
  • Antibiotics are not used in treatment of patients with patients with neuromuscular scoliosis.

  • Botulinum toxin
  • Botulinum toxin injections are used for a variety of spastic neuromuscular disorders, but not for treatment of neuromuscular scoliosis.

  • Corticosteroids
  • In patients with early DMD, corticosteroid therapy has been shown to stabilize muscle strength and should be initiated to maintain ambulatory capacity and prevent curve progression.

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