Osteoporosis monitoring, diagnosis, and treatment algorithm for patients with Duchenne muscular dystrophy. BMD, Bone mineral density; DMD, Duchenne muscular dystrophy; DXA, dual-energy x-ray absorptiometry. ∗Signs of clinically significant bone fragility are low-trauma fractures of long bones or vertebrae.^†Clinical stability refers to absence of nonvertebral fractures, stable healed vertebra fractures, absence of new vertebral fractures in previously normal vertebral bodies, absence of bone and back pain, and BMD Z score appropriate for height Z score or higher than 2 standard deviations.