MDF Magazine Issue 62 7 August 2020 (7)

Healthy
Winter Safety & Bone Health
By Parent Project Muscular Dystrophy
20 December 2019
With the official start of winter quickly approaching and
the icy weather already here, we want to remind your
family about the importance of safety, and also what to do if
and when accidents happen. People living with Duchenne,
especially those on steroids, are at risk for having weak
bones, a condition known as osteoporosis. Osteoporosis is
diagnosed when bones break with very little trauma, which
means they are more fragile due to low bone mineral density,
small bone size, or both.
Snow and ice can lead to unsafe, uneven surfaces, which
cause falls in the winter months. Falls are the most
common cause of long bone fractures, usually breaking
bones in the legs (i.e. femur, tibia, fibula). However, long
bone fractures can also happen after people with Duchenne
lose ambulation and can occur with very little trauma, such
as during a transfer or being lifted, or just being “bumped”
or injured with minimal pain or discomfort. Long bone
fractures, or significant bumps, put people living with
Duchenne at risk for Fat Embolism Syndrome (FES), a
life-threatening situation that requires immediate attention in
the emergency room and is a risk for losing ambulation. For
these, and many other reasons, it is important to stay safe.
Another type of bone fracture that can happen to people
living with Duchenne is a vertebral compression fracture.
When the bones of the spine (vertebrae) become osteoporotic
and thin, they may fracture without any trauma at all. This
type of fracture may be “silent,” or have minimal symptoms
at first; if left untreated, vertebral fractures are associated
with more vertebral fractures in the future and worsening
back pain.
For these, and many other reasons, it is important to stay
safe.
STAYING SAFE
It is recommended that you begin bone health monitoring
and fracture prevention at the time of diagnosis or at the
initiation of steroids. Here are some helpful hints:
It is important to stay safe to prevent falls, thus avoiding
fractures from happening. If your child is ambulatory, it is
important to keep shoes on most of the time to avoid slips,
keep paths in your house clear to avoid tripping, and watch
for overexertion. Children with Duchenne may get tired
more easily, and it is always a good idea to take a rest or use
mobility devices (scooters, etc.) when needed. Keep in mind
that some falls cannot be prevented despite every effort you
make.
If you or your child is not ambulatory, it is still important
to take safety precautions. This includes providing safe
transfers to chairs, beds, or in the shower. It is also important
to always wear seatbelts in wheelchairs, shower chairs, and
the car – if there is a seatbelt available on any device, use it!
As an extra precaution during the winter, it is advised that
ambulatory children, and caregivers who are assisting them,
wear “boot grips” (sometime called “Yaktrax”) on the soles
of the boots. They can help tremendously to avoid falls on
the snow and ice.
Weight-bearing exercises recommended by your doctor or
physical therapist (such as walking and standing as tolerated;
not to be confused with weight-lifting exercises) can help
your bones stay strong for a longer period of time. Ask your
doctor and physical therapist about safe exercises for arms
and legs.
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