Table 1.

Screening recommendations and course of action summary for children with DMD [26, 27].

Screening	Timing	Course of action
Back pain assessment	Each visit	If present, obtain vertebral imaging
Calcium intake and vitamin D intake (diet and amount of sun exposure)	Initial and subsequent visits	Calcium and vitamin D supplementation as needed; see Table 2.
Serum 25-hydroxyvitamin D	Every 1-2 years	Vitamin D insufficiency/deficiency treatment without clinical signs of rickets. Ergocalciferol or cholecalciferol dose based on vitamin D level: 20–30 ng/mL: 1000 IU PO daily, <20 ng/mL: 2000 IU PO daily, <10 ng/mL: 4000 IU PO daily. (i) Dose may need to be higher in patients with malabsorption, chronic glucocorticoids use, dark skin pigmentation, or obesity. (ii) Serum 25-OH vitamin D level should be repeated in 3 months after giving pharmacologic doses of vitamin D. (iii) When the level is optimal, vitamin D dose should be reduced to a supplementation dose at 400–800 IU/day (or higher in chronic glucocorticoid use).
Bone turnover markers	Not formally recommended at this time	Further research is needed and may be useful in monitoring bisphosphonate therapy.
DXA scan	Obtain baseline prior to glucocorticoid use every 1-2 years thereafter	If height-adjusted lumbar BMD Z score <−1, should repeat DXA in 1 year. Worsening BMD and/or BMD Z score or the gain in BMD is less than expected, consider vertebral imaging.
Vertebral imaging (X-rays or densitometric lateral spinal imaging)	Obtain if back pain present or lumbar height-adjusted Z-score < −2	If vertebral fracture is present, start bisphosphonate therapy.